Ministry of Health Annual report 2011

Ministry of Health

Annual report 2011

MINISTRY OF HEALTH

Annual Report 2011

November 2011

Dr Neil SharmaThe Minister for Health Ministry of Health Suva.

Dear Dr. Sharma.

I am pleased to submit to you the 2010 Annual Report in accordance to standard regulatory requirement of government.

[Dr Eloni Tora]Permanent Secretary for Health Ministry of Health.

m o h 2 0 1 1 a n n u a l r e p o r t

TABLE OF CONTENTSSection Page No.

1. Permanent Secretary’s Performance Statement 10

2. Overview of the Ministry of Health 11

3. Reporting on RDSSED(2009-2014) performance Indicators 14

4. 2011 Output Performance Reporting 17

5. Divisional Performance Reports 225.1 Central/Eastern Division 235.2 Western Division 245.3 Northern Division 245.4 Fiji Pharmaceutical and Bio-Medical Supplies (FPBS) 25

6. Health Outcome Performance Report 276.1. Non-Communicable Diseases 6.1.1.Diabetes 276.1.2. Cancers 296.1.3. Cardiovascular diseases 306.2. Communicable Diseases 316.2.1. Typhoid 316.2.2. Dengue 32 6.2.3. Leptospirosis 326.2.4. HIV 33 6.2.5. Tuberculosis (TB) 346.3. Maternal Child Health 35

7 Public Health Promotion 37

8 Environmental Health/Nutrition 41

9 Oral Health 50

10 Risk Management 52

11 Climate Change 55

12 Human Resource Management and Training 56

13 Health Research 61

14. Health Statistics 69

15. Overseas Patient Referral 75

16. Disease Trend Analysis 76

17. Donor Assisted Programs 81 18. MDG Accomplishment 82

19. Finance 85

20. Conclusion 90


List of TablesTable 1: Outcome 1 14Table 2: Outcome 2 16Table 3: Output 1 17Table 4: Output 2 18Table 5: Output 3 19Table 6: Output 4 19Table 7: Output 5 19Table 8: Output 6 20Table 9: Output 7 20Table10: Output 8 21Table 11: Output 9 21Table 12: Output 10 21Table 13: Interdependent Ministerial Deliverables 21Table 14: Government Health Facilities 23Table 15: Demography of Central / Eastern Division 23Table 16: Demography of Western Division 23Table 17: Demography of Northern Division 25Table 18: Policy Interventions 37Table 19: Priority Social Marketing campaigns implemented 38Table 20: Total Number of Participants Screened 39Table 21: Distribution Of Local Authority and Health Offices by Division 41Table 22: Surveillance of Sewage and Wastewater Disposal 42Table 23: Inspection of Drinking Water Supply 42Table 24: Nutrition and Dietetics 44Table 25: School Health Nutritional Status – Pre - School 45Table 26: School Health Nutritional Status – Primary School 45Table 27: School Health Nutritional Status – Secondary School 46


List of TablesTable 28: School Gardens 46Table 29: 1st Phase – Primary School [NIMS] 46Table 30: 2nd Phase – Maternal Child Health [NIMS] 47Table 31: Milk Supplementation program 48Table 32: Child Health – Nutritional Status 48Table 33: Maternal Health - Hb 49Table 34: Inpatients: Nutritional Status 49Table 35: Out- Patients: Nutritional Status 49Table 36: Dental Statistics 50Table 37: Notified & Confirmed Sentinel Events for the Divisions & 52 Sub divisional Hospitals including % of Events that resulted in Death for 2011Table 38: Category of Sentinel Events Reported in 2011 53 Table 39: Staff Establishment 56Table 40: Industrial Relations Report 56Table 41: IRD Cases for 2011 57Table 42: Scholarship and Training - Masters 57Table 43: Scholarship and Training – Post Graduate Diploma 58Table 44: Scholarship and Training - Bachelor 59Table 45: Scholarship and Training - Certificate 60Table 46: Research Register 62Table 47: Vital Statistics 69Table 48: Immunization Coverage 2011 69Table 49: Notifiable Disease Reported 2011 70Table 50: Divisional and Sub-Divisional Hospital Utilisation Statistics 71 ii) Specialised and Private Hospital 71Table 51: Top Ten causes of Mortality 2011 72 ii) Top Ten causes of Morbidity 2011 72Table 52: Health Status Indicators 2011 73Table 53: Types of cases assisted for overseas treatment for 2009-2011 75Table 54: Analysis by Diagnosis and Associated Costs 75Table 55: Donor Assisted Programs/Projects 2011 81 ii) Aid in kind 81Table 56: MDG Performance Indicator 82Table 57: Segregation of the 2011 Budget 85Table 58: Proportion against National Budget and GDP 85Table 59: Statement of Reciepts and Expenditure for the Yr ended 31st Decembver, 2011. 86Table 60: TMA Training Account for the Yr ended 31st December, 2011. 87Table 61: TMA Profit and Loss Statement for the Yr ended 31st December, 2011. 87Table 62: TMA Balance Sheet for the Yr ended 31st DECEMBER, 2011 88Table 63: Appropriation Statement for the Yr ended 31st December, 2011. 88


List of Figures

Figure 1 Guiding Principles of MoH 11Figure 2 Organisational Structure 2011 13Figure 3 Four Divisions within Republic of Fiji 22Figure 4 Diabetes by Age – Group 2011 27Figure 5 Diabetes by Facility 2011 28Figure 6 Sex Distribution of Diabetes New Cases 2011 28Figure 7 Top 5 Female Cancer Sites 2011 29Figure 8 Top 5 Male Cancer Sites 2011 30Figure 9 Top 3 Cardiovascular Diseases Conditions 2011 30


AppendicesFigure 10 Typhoid Cases for 2011 by Month 31Figure 11 Dengue Cases for 2011 by Month 32Figure 12 Leptospirosis Cases for 2011 by Month 33Figure 13 HIV New cases from 1989-2011 33Figure 14 TB Indicators by Division 2011 34Figure 15 Under 5 Mortality Ratio for Fiji 1969-2011 35Figure 16 Maternal Mortality Ratio 2000 – 2011 35Figure 17 Contraceptive Prevalence Rate (per 1000 CBA) 36Figure 18 Percentage of 1 year olds immunized against Measles 36Figure 19 Overall Status 39Figure 20 Status by Gender 40Figure 21 Principle Incident Types 2011 54Figure 22 The Threshold effects of Minimum Temperature on Dengue in the Bua Sub-Division 55Figure 23 Diabetes Cases from 2000 – 2011 76Figure 24 Cancer Cases from 2000 – 2011 76Figure 25 Sexually Transmitted Infection Cases from 2000 – 2011 77Figure 26 Cardiac Related cases from 2000 – 2011 77Figure 27 Depression Cases from 2001 – 2011 78Figure 28 Kidney Cases from 2000 – 2011 78Figure 29 Typhoid Cases from 2000 – 2011 79Figure 30 Typhoid Cases by Divisions 2000 – 2011 79Figure 31 Dengue Fever Cases from 2000 – 2011 80Figure 32 Leptospirosis Cases from 2000 - 2011 80Figure 33 Independent Auditors Report 83Figure 34 Management Certificate for Financial Statements 84


Key Abbreviations

Aus AID Australian Assistance International Development IMCI Integrated Management of

Childhood Illnesses AHD Adolescent Health Development JCU James Cook University

APLS Advance Paediatric Life Support JICA Japanese International Cooperation Agency

BCG Bacillus Calmette-Guerin KPI Key Performance Indicators

BFHI Baby Friendly Hospital Initiative KOICA Korean International Cooperation Agency

CBA Child Bearing Age MARYP Most At Risk Youth Population

CBH Central Board of Health MBBS Bachelor of Medicine and Bachelor of Surgery

CD Communicable Diseases MCDC Medical Cause of Death Certificate

CG Clinical Governance MDG Millennium Development Goal CPG Clinical Practice Guidelines MDA Mass Drug Administration

CQI Continuous Quality Improvement MOFNP Ministry of Finance & National Planning

CSP Clinical Services Plan MoH Ministry of Health CSN Clinical Services Network MR Measles and Rubella CWMH Colonial War Memorial Hospital NCD Non-communicable Disease

DIPI Director Information Planning & Infrastructure NHEC National Health Executive

Committee

DMFT Decayed Missing Filled Teeth (Permanent) OPV Oral Polio Vaccine

DNS Director Nursing PATIS Patient Information System DOTS Directly Observed Treatment PH Public Health

DPBS Director Pharmaceutical & Biomedical Services PHIS Public Health Information

System

DPT Diphtheria, Pertussis Tetanus PMTCT Prevention of Mother to Child Transmission

DSAF Deputy Secretary Administration Services POLHN Pacific Open Learning Health

Network DSHS Deputy Secretary Hospital Services PS Permanent Secretary DSPH Deputy Secretary Public Health PSC Public Service Commission EHO Environmental Health Officers PSH Permanent Secretary for Health EPI Expanded Program on Immunization RCA Root Course Analysis EU European Union RM Risk Manager

FCTC Framework on the Control of Tobacco Convention R/T Radio and Telephone

FHSSP Fiji Health Sector Support Program SAHT Sydney Adventist Hospital Net

FIBS Fiji Island Bureau Statistics SEEDS Sustainable Economic & Empowerment Development Strategy

FIT Fiji Institute of Technology STI Sexually Transmitted Infections FMR Financial Management Reform SLWP Study Leave With Pay

FNRERC Fiji National Research Ethics and Review Committee SLWOP Study Leave without Pay

FNU Fiji National University TB Tuberculosis FPBS Fiji Pharmaceutical Biomedical Service U5MR Under 5 Mortality Rate

FSMED Fiji School of Medicine UNICEF United Nation International Children Emergency Fund

FSN Fiji School of Nursing USA United States of America GDP Gross Domestic Product VOSO Visiting Ophthalmic Services

Key Abbreviations



GOF Government of Fiji WHO World Health Organization GOPD General Outpatients Department SLWP Study Leave with Pay GWE Government Wage Earner SLWOP Study Leave with out Pay

HBV Hepatitis B Virus NHEC National Health Executive Committee

HPV Human Papilloma Virus Vaccine RCA Root Cause Analysis

H/C Health Center UNFPA United Nations Fund for Population Activities

Hib Haemophilus Influenza Type B YFS Youth Friendly Services

HIV/AIDS Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome VCCT Voluntary Confidential

Counseling Test FNU Fiji National University HITH Hospital in the Home HQ Head Quarters

SECTION 1.0: Permanent Secretary’s Introductory Remarks

The importance of having the Ministry’s performance in the delivery of health services measured and reported to against the previous years’ results has driven the Ministry to embark on a more output or result-based reporting structure.

The Ministry of Health’s 2011 Annual Report provides the measure of the impact its programs and activities have made to the Health Outcomes captured under the Ministry’s 2011-2015 Strategic Plan. This approach of measuring the impact of programs and activities provides at a glance, in the form of the Ministry’s Annual Report, how we have performed in achieving the 2011 national and international targets.

As the Annual Report also identifies success areas as well as areas needing improvement, it provides existing and interested development partners useful information on possible areas for future collaboration and support.

Despite resource challenges, the Ministry has made significant progress in achieving the health strategic objectives of the Government’s Roadmap to Democracy and Sustainable Socio-Economic Development (RDSSED) and the ever challenging Millennium Development Goals (MDG’s).

The challenge to the provision of quality health care provided by the increasing communicable and non-com-municable disease burdens coupled with resource constraints makes justification for the Ministry’s preferred focus on wellness in the coming years. Future Annual Reports of the Ministry will hopefully indicate the measure of success of its efforts in this innovative approach.

The Ministry’s 2011 achievements would not have been possible without the efforts and commitments of our staff as well as our local and international development partners. Our staffs who have often bravely gone far beyond their call of duty to achieve targets and save lives despite facing numerous challenges deserve praise and support.

Finally, I call upon all stakeholders to stand besides Fiji’s health workers in rising up to the challenge of improving the health and wellness of the nation. I firmly believe that this is possible with the Blessings of the Good Lord on our side.

God Bless Fiji.

[Dr. Eloni Tora]Permanent Secretary for Health


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SECTION 2.0: Overview

The Ministry of Health of the Republic of Fiji endorses the statement in the preamble of the Constitution of the World Health Organization (WHO), which states:

“The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, and political belief, economic and social condition.”

The Ministry of Health of the Republic of Fiji therefore acknowledges that it is the fundamental right of every citizen of the nation, irrespective of ethnicity, gender, creed or socio-economic status to have access to a national health system providing quality health care with respect to accessibility, affordability, efficiency and a strengthened partnership with the communities for which this healthcare is provisioned, in order to improve the quality of life of the citizens of the Republic of Fiji.

GUIDING PRINCIPLES:

Figure 1: Guiding Principles of MoH

VISION: A healthy populatoon driven by a caring Health Care Delivery System

MISSION: to provide a high quality health care delivery system by a caring and commtted workforce working with strategic partners through good governance, appropriate technology and appropriate risk management facilitating a focus on patient safety and best health status for the citizens of Fiji.

VALUES: the Ministry of Health strives to uphold customer focus, respect for human dignity, quality, equity, integrity, responsiveness and faithfulness as paramount values for the achievement of its mission and vision.

Ministerial Assignment:

The Ministry of Health under legal notice is responsible for:

Business Departments1. Clinical Medical Services 1. Divisional Hospitals2. Health Promotion 2. Sub-Divisional Hospitals3. Medical Equipment and Supplies Services 3. Health Centers and Nursing Stations4. Pharmaceutical Drugs and Medicine Services 4. Oral Health department5. Preventive Health/Public Health programs and 5. Fiji Biomedical and Pharmaceutical Services Services 6. National Centre for Health Promotion6. Primary Health Care Services 7. National Referral Hospitals (St. Giles and 7. Continuing Professional Staff Development Twomey/Rehab/TB Hospitals) and Management 8. National Centre for Communicable Disease Control 9. Senior Citizen’s Homes


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Legislations and Decrees regulating the business undertakings of the MoH and pertaining to its activities are listed below:

1. Animal (Control of Experiments) Act (Cap 161)2. Burial and Cremation (Cap 117)3. Dangerous Drugs Act (Cap 114)4. Fiji School of Medicine Act 19975. Fiji National University Decree 20096. Food Safety Act 20037. Medical Imaging Technologist Decree 20098. Radiation Health Decree 20099. Medical and Dental Practitioners Decree 201010. Medical Assistant’s Act (Cap. 113)11. Mental Health Decree 201012. HIV Decree 201013. Marketing Controls (Foods for Infants and young Children Regulations) 201014. Nurses Midwives and Nurses Practitioners Act (Cap 256)15. Pharmacy and Poisons Act (Cap 115)16. Private Hospitals Act (Cap 256A)17. Public Health Act (Cap 111)18. Public Hospitals and Dispensaries Act (Cap 110)19. Quarantine Act (Cap 112)20. Radiation Health Decree 200921. Tobacco Control Act 199822. HIV/AIDS (Amended) Decree 201123. National Ambulance Decree 201024. Allied Health Practitioners Decree201125. Nursing Decree 201126. Radiation Health Decree 2009

The following boards/councils that are administered by the Ministry:

1] Private Hospital Board2] Radiation Health Board3] Pharmacy and Poisons Board4] Fiji Optometrists Board5] Fiji Dental Council Board6] Fiji Medical Council Board7] Board of Visitors- All Major Hospitals, Sub-divisional Hospitals & Health centres.8] Allied Practitioners Board (In progress)9] Fiji HIV Board

Figure 2: Organizational Structure 2011

Figure 2: Organizational Structure 2011

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SECTION 3.0: OUTCOME REPORTING ON ROADMAP FOR DEMOCRACY AND SUSTAINABLE SOCIO-ECONOMIC DEVELOPMENT 2009-2014 (RDSSED).

3.1 Outcome 1: Communities are serviced by adequate primary and preventative health services thereby protecting, promoting and supporting their well being.

Table 1 – RDSSED Performance Indicators

Key Pillar(s) PCCPP

Targeted Outcome (Goal/Policy Objective RDSSED)

Outcome Performance Indicators or Measures (Key Performance Indicators –RDSSED)

2010 2011

Pillar 10: Improving Health Service Delivery

Communities are serviced by adequate primary and preventative health services thereby protecting, promoting and supporting their well being.

Child mortality rate reduced From 26 to 20 per 1000 live Births (MDG).

17.7 20.95

Percentage of one year olds Immunised against measles Increased from 68% to 95% (MDG).

71.8 82.5

Maternal mortality ratio reduced from 50 to 20 per 100,000 live births (MDG).

22.6 39.21

Prevalence of diabetes in 15-64yrs age reduced from 16% to 14% (note: baseline and target may need revision).

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Contraceptive prevalence rate (CPR) amongst population of child bearing age increased from 46% to 56% (MDG).

31.77 36.5

Increased Fiji resident medical graduates from FSMed from 40 to 50 per year

41 42

Increase annual budgetary allocation to the health sector by 0.5% of the GDP annually.An annual growth rate of 5% over the medium term

NA No increase as compared to 2010 % of Health Budget to GDP

Average length of stay for in-patient treatment reduced from 7 to 5 days

7.11 5.8

Prevalence rate of STIs among men and women aged 15 to 25.

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1 8 maternal deaths in 2011 compared to 5 in 2010. Note that even 1 maternal death can dramatically increase the maternal mortality ratio.2 Survey required (to report prevalence). At last NCD STEPS Survey (2002), prevalence was 16%.3 Survey required to report prevalence

Table 1: RDSSED Performance Indicators

There has been a slight increase in child and maternal mortality rates compared to 2010. A total of 8 maternal deaths were reported compared to 5 the previous year. Due to low number of maternal deaths, the maternal mortality ratio can vary a lot from year to year. The immunisation rate for measles has improved from 71.8% in 2010 to 82.5% in 2011 through routine reports. However, coverage surveys have shown higher rates (e.g. 94% in 2008), which suggests that there is scope for improving routine reporting. The revised Public Health Information System, which will be implemented from 2013, is expected to improve the accuracy of our coverage rates. With regards to Diabetes, admission rates increased in 2011 compared to 2010 and similarly more amputations were reported. Slight improvement in contraceptive prevalence was noted and there was a drop in teenage pregnancy in 2011 compared to the previous year. However, the prevalence of anaemia in pregnancy at booking increased by 2%.


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3.2 Outcome 2: Communities have access to effective, efficient and quality clinical health care and rehabilitation services

Table 2 Key Pillar(s) PCCPP

Targeted Outcome (Goal/Policy Objective RDSSED)

Outcome Performance Indicators or Measures (Key Performance Indicators –RDSSED)

2010 2011

Pillar 10: Improving Health Service Delivery

Communities have access to effective, efficient and quality clinical health care and rehabilitation services.

Participation of private and health care providers increased from 2 to 10.

NA NA

Health (actual) expenditure increased from the current 2.92% to at least 5% of GDP by 2013

NA 2.4% of Nominal GDP

Increase annual budgetary allocation to the health sector by 0.5% of the GDP annually.

NA No increase as compared to 2010 % of Health Budget to GDP

Doctors per 100,000 populations increased from 36 to 42.

38.3 39.9

Outsourcing non-technical activities such as laundry, kitchen and security by end of 2011

NA Services outsourced are Cleaning and Security by end of 2011 Laundry and Kitchen are still in the process

Health Policy Commission established by 2011

NA The Health Policy Commission is expected to be established by the end of 2012

Average length of stay for in-patient treatment reduced from 7 to 5 days

7.11 5.8

Elimination of stock outs of drugs from present 100 items per month

72 85

‘Proportion of tuberculosis cases detected and cured under directly observed treatment short course (DOTS)’.

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Bed Occupancy Rate of Psychiatric beds

108.25 109.61

Number of staff trained in mental health

15 172

1 As of this time, the cure rate cannot be calculated since TB treatment implements a six to nine months course of anti-TB drugs (DOTS strategy). Final cure rate figures can be calculated by end of September.

Whilst the average length of stay overall has reduced from 7.1 to about 5.8, the bed occupancy rate of Psychiatric beds remains high. There has been a 11 fold rise in the number of staff trained in mental health. These include 11 nurses trained in PG certificate in mental health, 161 through other inservice trainings in mental health. The Doctors to population ratio has increased slightly but is still falls short of the target.

Table 2


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SECTION 4.0: 2011 Output Performance Reporting

The Ministry of Health in reporting its achievements for 2011, has re-engineered its focus and approach more on an output based reporting of its results and achievements rather than focussing on units, sections and divisions. Such reporting would ensure that the Ministries key deliverables as per the programs and pro-jects captures programs and projects that are aligned to delivering the strategic outcomes of the Ministry as outlined in the Strategic Plan 2011-2015.

Primarily, focus was on how divisions had performed rather then how the programs, projects and activities had influenced or directly impacted on the key Health Indicators or contributed towards primary health care or its contribution towards achieving NCD objectives and other major outputs of the Ministry. Focus would be more on the how the programs and projects have made an impact on key indicators captured in the Strate-gic and Annual Plans.

Ten outputs were identified by the Ministry of Health in 2011 in aligning its yearly plan to the 5 year Strate-gic Plan. The day to day activities were derived from the 65 strategies come Key Performance Indicators that the Ministry of Health had targeted for in 2011.

It is only appropriate that the achievements on the KPIs in each of its respective output is outlined and re-ported to, in order to understand and assess what was targeted, what was achieved, where are we now, where do we go on from here, what were some challenges/obstacles faced and how do we re-engineer our approach to further improve on achieving our outputs for the following year. As per the Annual Corporate Plan for 2011 the following outputs were to be delivered by the Ministry of Health.

Output 1 – Portfolio Leadership Policy Advice & Secretariat Support

A total of 13 strategies/key performance indicators were identified to be delivered under Output 1 on Port-folio Leadership Policy Advice & Secretariat Support. The respective output captures the Ministries deliv-erables on the formulation of new policies, review of policies, plans and processes and establishment of new units, committees and other secretarial logistics that ensure the best of advice is provided to the Minister and Cabinet on national issues related to the Ministry of Health. This ensures the Ministry is able to capture and incorporate the changes in health related dynamics (laws, regulations, international standards, change in dynamics of diseases, finance etc) in its plans and policies to improve further in delivering our services to all citizens of Fiji.

Table 3: Output 1 – Portfolio Leadership Policy Advice and Secretariat Support

Output Major Achievements 1. Portfolio Leadership Policy Advice & Secretarial Support.

Mental Health Review Board, National Mental Health Advisory Council and Board of Mental Health Visitors have been established in accordance with the provision of the Decree.

In compliance with the provision of the Decree, Stress Management Wards (SMW) have been established in the Northern Division (5-beds), Western Division (10-beds) and Cent/East Division (8-beds) and they are now fully operational.

Mental Health Policy and Implementation Action Plan were presented to NHEC which was endorsed with recommendation for further review.

Health Information Policy developed. Health Information Strategic Plan developed. Pharmacy Profession Decree and Medicinal Products Decree implemented.

Table 3: Output 1 – Portfolio Leadership Policy Advice and Secretariat Support


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Output 2 – Public Awareness Promotions- Public Health

A total of 10 strategies/key performance indicators were identified to be delivered under Output 2 on Public Awareness Promotions – Public Health. The respective output captures the Ministries deliverables on educat-ing preventative measures to public on health related issues such as dengue, smoking, diabetes, nutrition, oral health through promotional campaigns. Simultaneously, educational programmes on various preventative measures such as physical activities and nutrition are promoted through private sector as well as line Ministries.

Table 4: Public Awareness Promotions- Public Health Output Major Achievements 2. Public Awareness Promotions-Public Health

Various numbers of programs were conducted in all divisions emanating from the FPAN COMBI Plan. Focal areas targeted were in the area of Food Security, Improving maternal nutrition, Improving Child Nutrition, NCD, Education Support Materials through the Ministry of Education etc.

Oral Health Outreach Programs were successfully implemented. 4 quarterly based physical activity were conducted in all major

divisions NIMS marketing campaign was developed and implemented in

Schools covering all 4 major divisions. Anti Smoking Promotion Programmes were conducted on tobacco

free initiatives, essay competition, oratory competition, drama, poster competition at Vunisea, Kadavu. Enforcement, Registration, Media Campaign and budget expenditure.

>40% of Strategies from Annual Work Plan derived from National Centre for Health Promotion Strategic Plan was implemented through different means of promoting health.

Food Safety Decree legislated and ready for implementation.

Output 3 – Emergency Response Services – Medical Evacuations (Local) and Blood Supply.

A total of 3 strategies/key performance indicators were identified to be delivered under Output 3 on Emergency Response Services – Medical Evacuations (Local) and Blood Supply. The respective output captures the Ministries deliverables on the readiness of critical response teams on emergency evacuations as well as the availability of supply of blood to emergency cases.

Table 4: Public Awareness Promotions- Public Health


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Implementation of Health Information System (HIS), Patient Information

System (PATIS) and Laboratory Information System (LIS). Registration of all health professionals was undertaken in 2011 and will

continue into 2012. Production of National Health Accounts 2009-2010 In accordance with-the HIV Decree, the HIV Board was established

Table 5: Emergency Response Services-Medical Evacuations(Local) and Blood Supply Output Major Achievements 3. Emergency Response Services – Medical Evacuations (Local) and Blood Supply.

The development of the Draft Disaster Strategic Plan for 2012 and 2015 has been completed and is awaiting the completion of the National Disaster Strategic Plan to which the Ministry Plan has to take queue to finalise the plan for endorsement.

Mock exercises were conducted in all major divisions and as

targeted more than 80 % of the strategies were implemented from the National Blood Service Strategic Plan.

Output 4 – Communicable Disease Prevention

A total of 6 strategies/key performance indicators were identified to be delivered under Output 4 on Com-municable Disease Prevention. The respective output captures the Ministries deliverables on development of standard guidelines at operational level specific to test and monitor communicable diseases, social mobilisa-tions interventions, immunization programs to reduce the burdens of these CD’s.

Table 6

Output Major Achievements 4.Communicable Disease (CD) Prevention

A draft CD Lab Testing guideline has been developed for all Primary Care Health Facilities.

Majority of strategies from CD Surveillance Outbreak Guideline was implemented through CD bulletin reports, Pacific syndromic surveillance weekly report, Pacific syndromic surveillance report.

TB Control Programs were strengthened in Tamavua. Formulation of the TB Strategic Plan 2011-2015. Development of Typhoid Management Guidelines

Output 5 – Provision of Clinical Services

A total of 11 strategies/key performance indicators were identified to be delivered under Output 5 on Provi-sion of Clinical Services. The respective output captures the Ministries deliverables on the provision of wide range of quality, effective and efficient health care to the citizens of Fiji at first point of contact at all Public Health Facilities with full confidentiality of patient information maintained all the time.

Table 7 Output Major Achievements 5. Provision of Clinical Services.

Patient Satisfaction Surveys were carried out in selected health facilities to explore areas of weaknesses that needed more emphasis.

80% of risk management strategies in divisional hospitals were implemented and common risks were identified and categorised to ensure that necessary procedural changes or policies could be formulated to minimize risks involved.

In order to improve on Turn around Time (TAT) for communication on pap smear results, Pathologists and Cytology Services were centralised.

Baby Friendly Hospitals Initiative (BFHI) 18 hours training conducted in the Divisions with internal audits was undertaken. BFHI policies and the 10 steps to Breastfeeding were maintained in all Maternity facilities.

Training on protocols were successfully undertaken to strengthen emergency neonatal care in all Paediatric Units.

Table 5: Emergency Response Services-Medical Evacuations(Local) and Blood Supply

Table 6

Table 7


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Output 6 – Provision of Primary Health Care

A total of 12 strategies/key performance indicators were identified to be delivered under Output 6 on Provi-sion of Primary Health Care. The respective output captures the Ministries deliverables on improving the provision of wide range of quality, effective and efficient and accessible primary health care to the citizens of Fiji at all Public Health Facilities with full confidentiality of patient information maintained.

Output 7 – Education and Training – Disease control and Health Promotion

A total of 3 strategies/key performance indicators were identified to be delivered under Output 7 on Edu-cation and Training targeted towards Disease Control and Health Promotion. Specific training needs were identified through the In-Service Training Plan to ensure that our staffs that were directly involved in disease control and Health promotion were up skilled. Given the changes in dynamics of diseases nowadays, it was important that the Ministry of Health targeted its training needs to effective health promotion strategies to control or mitigate the change in dynamics of diseases.

Output 8 – Education and Training – Nurses

A total of 2 strategies/key performance indicators were identified to be delivered under Output 8 on Education and Training targeted towards up skilling Nurses. In view of the shortage of numbers and quality of nurses and also providing incentives through academic up skilling, the Ministry of Health tar-geted a good number of training to be provided to nurses. Retaining nurses has been a major challenge for the Ministry and other strategies needs to be developed to further strengthen our nursing manpower.

Output Major Achievements 6. Provision of Primary Health Care.

Develop strategies and implementation schedule for each division in consultation with relevant stakeholders on increased community access to safe sanitation and access to safe water.

Number of campaigns was undertaken advocating breast feeding in all health facilities per Quarter.

IMCI protocols were introduced to 2 health facilities per quarter through training and clinical practice.

Reproductive Health Policy was developed through a coordinated approach by Public Health, Paediatric and O&G. The Policy outlines the strategies adopted to reduce maternity, infant & child mortality rates in all divisions starting with training.

As part of the NCD Work Plan, an MOU was signed between MoH and FNU for the NCD STEPS Survey for 2011.

The establishment of Diabetic/Renal Hubs at the Satellite Health Centre and Lautoka Hospital. Work is in Progress.

Maintenance of Health Facilities Rezoning of Nausori Hospital

Table 8

Table 9

Output Major Achievements 7. Education and Training (Disease control and Health Promotion)

Increased numbers of staff were trained in mental Health Care which included lectures given by visiting psychiatrist in Labasa and the Western Division.

Specialised trainings were identified for critical health professionals.


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Table 10 Output Major Achievements 8. Education and Training - Nurses.

More then 100 registered nurses underwent formal post-registration training

Continuous professional development was facilitated in all divisions targeting nurses.

Output 9 – Hospice Services – Accommodation and Assistance for the ElderlyThe strategy on Hospice Services – Accommodation and Assistance for the Elderly refers to the old citizens homes all over Fiji. The Ministry ensured that through the provision of appropriate equipments, facility developments and regular medical care, the old were looked after properly.

Table 11 Output Major Achievements 9. Hospice Services – Accommodation and Assistance for the Elderly.

Continuous care of the elderly and upgrading of infrastructure was maintained.

Output 10- Supply of Goods Medical Drugs and ConsumablesA total of 7 strategies/key performance indicators were identified to be delivered under Output 10 on Supply of Goods Medical Drugs and Consumables. The strategies formulated was required to bring about major changes and improvement to the management of procurement of medical drugs and consumables in order to keep the proper amount of stock available for all health facilities in Fiji at all times without much anomalies and discrepancy.

Table 12 Output Major Achievements 10. Supply of Goods – Medical Drugs and Consumables.

Completion of review of prequalification for supply of medicines. This would ensure that Fiji opens its procurement tender to untapped market such as India for the supply of medicines.

Procurement Plan for 2011 developed. Internal Audit was conducted on inventory management in

appropriate health facilities. Customer Satisfaction Survey was undertaken in appropriate health

facilities. Inventory management training of health facility staff on inventory

management was conducted.

Table 13 Outcome Public Sector Reform

Development of Service Charter for the Ministry of Health Outsourcing of Cleaning Services

Gender Equality and Women in Development

Equal training opportunities at all levels of the Ministry Extraction of gender segregated data from the HRIS system

Poverty Reduction Decentralization of Stress Management Wards in the three major

divisions. Mental Health outreach programs successfully undertaken. Community based rehabilitation programs were conducted for the

disabled population. Children Under 15 and ex-serviceman exempted from dental fees.

Table 10

Table 11

Table 12

Table 13


2 1

SECTION 5.0: Divisional Performance Report 2011

The Divisional Performance Reports for 2011 are reflective of the improvements and innovative ideas that were implemented during the course of the past year. The improvements, strengthening of public health activities and the achievement of the public health objectives had a positive impact on the delivery of health services, especially in both urban and rural health facilities.

The MoH provisions health service delivery throughout the four divisions in the Republic of Fiji: the Central division; the Eastern division, the Western division and the Northern division. The health services provided range from general outpatient services, special outpatient services, inpatient services, maternal child health care services, oral health services, pharmacy services, laboratory services, environmental health services, and physiotherapy services, as well as outreach and specialist clinical services.

Figure 3: Four Divisions within Fiji.


2 2

Table 14

5.1 Central Eastern Division:

This division is the largest by population size and caters to a myriad of health facilities. The total number of people in this division is 400221. The greatest of which reside in the Suva sub-division (209 834).The division is further divided into 10 sub-divisions: Central -Suva, Serua/Namosi, Rewa, Tailevu, Naitasiri; Eastern – Lomaiviti, Lakeba, Lomaloma, Rotuma and Kadavu.

Table 15: Demography of Cent / East Subdivision Total Suva 209834 Rewa 81795 Naitasiri 20281 Serua/Namosi 26116 Tailevu 21380 Lomaiviti 17585 Kadavu 10767 Lomaloma 3218 Lakeba 7338 Rotuma 1907 Total 400 221 Central (total population) - 359406 Eastern- (total population) – 40815

Table 15: Demography of Cent / East


2 3

5.2 Western Division

The Western Health Services Divisional office oversees the affairs of the six medical subdivisions in the Western Division namely Ra, Tavua, Ba, Lautoka/ Yasawa, Nadi and Nadroga/ Navosa.The subdivisional health services comprises of clinical services provisions through the subdivisional and specialist hospitals, the health centres, nursing stations, dental departments and other allied health services, adolescent health and community rehabilitation activities. All subdivisional hospitals provide laundry, kitchen and hospitality support and mortuary services. Community and environmental health constitutes a major part of western health service activities.

Table 16: Demography of Western Division

Subdivision Total Ra 30 118 Tavua 27 342 Ba 58 538 Lautoka/Yasawa 104 485 Nadi 86 676 Nadroga/Navosa 54 021 Total 361 180

The western health services were provided with an operation budget of $27,661,615.00 for the year 2011 business year.

The highlights for the year included: • Official opening of Loma Nursing Station • Commencement of Construction of the Kidney Diabetes Hub Centre, Lautoka Hospital • Construction and official opening of Balevuto mortuary in Ba • Opening of Ba vision centre • Opening of the Nasau Mortuary and provision of a generator from the Commissioner Western’s office • Opening of Viseisei Sai Health Centre • Successful Oral Health outreach programme extended to Colo west, Colo north and Maritime upon proposed funds approved • Containment of typhoid outbreak at Nanoko after public health emergency declaration • Training of all Rural Local Authority Sectaries on Basic Financial Management and audit of all RLA grants • Supervision and inspection of MoH renovation/ maintenance of capital projects as directed by Honourable Minister for Health

5.3 Northern DivisionThe Northern Health Service – Public Health Division provide services to four subdivisions, namely Bua, Cakaudrove, Macuata and Taveuni as the health facilities are listed as follows: • 3 Sub- divisional Hospitals • 19 Health Centres • 21 Nursing Stations • 4 Environmental Health Offices • 1 Old Peoples Home (Babasiga Ashram)

Table 16: Demography of Western Division


2 4

Table 17: Demography of Northern Division Subdivision Total Population Bua 15 286 Cakaudrove 31 880 Macuata 74 052 Taveuni 16 369 Total 137 587

Capital projects included: • New Savusavu Hospital A&E extension commenced operation on October 2011 • Nabouwalu Hospital Duplex Quarters opened in October 21 2011 • Babasiga Ashram Greenhouse completion on December 2011 • Upgrading of Laundry Facilities (new washing, dryer and ironing machines) for Taveuni, Savusavu and Nabouwalu Hospitals • Relocation of Bua Nursing station: work commenced on December 2011

Minor Projects • Maintenance and repair of RT and solar system in all the stations • General maintenance of Taveuni Hospital • Minor and urgent repairs in the different health facilities in the division • Upgrading of IT systems in all subdivisional hospitals

New Vessels received from FHSSP: • Adi Beti vessel as sea ambulance for Taveuni subdivision on 11/03/211 • Nasi Yalodina II vessel for Macuata subdivision on 11/03/2011

New Vehicles received: • Mazda GN 964 – Nabouwalu Hospital ambulance on 10/03/11 • Mazda GN 037 – Tukavesi H/C ambulance on 15/03/11 • Mazda GN 039 – Taveuni Hospital ambulance on 15/03/11 • GP 123 - New ambulance donated by Rotary

5.4 Fiji Pharmaceutical and Bio Medical Supplies DivisionThe Fiji Pharmaceutical and Bio-Medical Supplies division in 2011 identified key strategic areas that were targeted to ensure appropriate interventions were implemented in achieving their key deliverables.

I. Procurement Strategy- Key recommendations of the short term advisor in 2010 were implemented in the Drug Tender called for 2011. The implications of these interventions are to reduce wastage and supply delay from contracted suppliers of FPBS. Impact analysis will be conducted in January 2014 to evaluate improvement progress.

II. Strengthening skilled Human Resources -Key to ensuring timely flow of inbound and outbound stocks depends on the capability of the floor manager in overseeing the operations and carefully managing the staff, stock movement and workload per time. The impact to this has been a remarkable improvement in the turn-around time of orders reaching the facilities.

Table 17: Demography of Northern Division


2 5

III. Strengthening Warehouse Inventory Management System - Ministry of Health has endorsed that FPBS to pursue the purchase of the Inventory Warehouse Management System to be an added application of the cur-rent inventory application existed.

IV. Establishment of the Logistic Management Unit - LMU was established in September 2011 to play the pivotal role in improving the logistic system. The unit is made up of the Lab and Dental Technician, a nurse, a pharmacist and a data analyst. The key roles of this unit are data management, quantification, coordination and collaboration, system revision, supervision, implementation and trainings. LMU has established group emails for our customers to enable FPBS to communicate issues pertaining to stock updates. These enable the customers to be well informed of issues beforehand as patients can be managed adequately.

V. Inventory Management Standard Operating Procedures - With the assistance of the GMU, collabora-tively, the Inventory Management SOP for health facilities was developed and distributed to some facilities in 2011. This manual is to supplement the training conducted for the nurses as to reinforce the knowledge that has been shared during the sessions. FPBS has successfully implemented the organisation SOP in 2011. The objective of the SOP is to bring about order in the process and system of work at FPBS which has been un-der a lot of review lately. The current SOP is yet to be perfected as the implementation process has forecasted teething and influencing people’s behavior into standard behavior being the key challenge.


2 6


2 7

SECTION 6.0: Health Outcome Performance Report 2011

6.1 Non- Communicable Disease

The National Non-Communicable Diseases Programme/Unit is responsible for planning, coordinating and implementing the various activities of the National NCD Strategic Plan 2010-2014. The Unit coordinates these activities from the national level and works with the divisions and subdivisions in striving to achieve the goals and objectives of the programme.

Year 2011 akin to the previous years had been challenging and interesting. There were some major and new activities that were implemented and some have been proposed and would be implemented in 2012. The major activity of 2011 was conducting the NCD STEPS survey on the national level. With its completion, data entry resumed with Fiji National University (C-POND).

There were efforts made to collaborate with more stakeholders and conduct more NCD related activities and programmes. Massive community awareness was done during the National NCD Month in November whereby it was the first time that the Unit had expanded the NCD week programme to NCD month. The year closed with the National Diabetes Meeting at the national level.

6.1.1 Diabetes

Fiji realises the colossal battle it faces in preventing the prevalence of diabetes in our ageing population and at the same time minimizing the cost of services provided to those already diagnosed with Diabetes including treatment and recovery services.

It is further alarming that more female’s form a major percentage of those diagnosed with diabetes within the age of 50-59.

Figure 4: Diabetes by Age Groups for 2011

2 2 11

26 41

79 88

118 107

62

44 49

16

0

20

40

60

80

100

120

140

Num

ber

of c

ases

Age-Groups

Diabetes by Age-Groups, 2011

Source: Diabetes Notification Forms, 2011

Figure 4: Diabetes by Age Groups for 2011

Data on Diabetes new cases captured through the Diabetes notification forms has been underreported in 2011. However, based on the existing data, those in the 50-59 age groups are most affected.

Figure 5: Diabetes by Facility for 2011

17 18 8

20

7 17 13

3

33

9 14

41

26

1

22

111 103

3

26 19

12 5

15

1 9

3

37 41

2 9

0

20

40

60

80

100

120Ba

Bale…

Beqa CW…

Dre…

Gau

Kav…

Kese Kor…

Kor…

Lab…

Laut…

Lek…

Lev…

Nad

iNa…

Nat…

Nau…

Nav…

ND

C RaRa

biSa

in…

Sav…

Tav…

Tavu

aVa

le…

Vuni…

Wai…

Num

ber

of C

ases

Facility

Diabetes by Facility 2011


Nadi and Namaka have been reporting the highest number of new cases of diabetes in 2011. However, this may be attributed to underreporting from other facilities

Figure 6: New Cases of Diabetes by Sex

382, 59%

263, 41%

Sex Distribution of Diabetes New Cases, 2011 Female Male


More females (59%) than males (41%) have been diagnosed in 2011.

Figure 5: Diabetes by Facility for 2011

Figure 6: New Cases of Diabetes by Sex


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6.1.2 Cancer

The Ministry has always faced a major challenge in increasing coverage and accessibility of screening wom-en aged between 30-59 years of age for cervical cancer and breast cancer given the two top list of cancer amongst women and in totality cancer being more common among women and men. Ongoing screening programs for cervical (pap smear) and breast cancer at sub-divisional levels have been conducted more frequently by the Ministry in collaboration with private partners. Furthermore, events that bring together large crowds are seen as an avenue where more such tests could be taken hence the lengthening of NCD week to NCD month at sub-divisional levels in 2011.

Figure 7: Top 5 Female Cancer Site for 2011

233

164 167

25 22

0

50

100

150

200

250

Cervix Breast Uterus Unknown Primary Site Ovary

Num

ber

of C

ases

Cancer Sites

Top 5 Female Cancer Sites, 2011

Source: Cancer Registry, 2011

The main cancer sites among females have been cervical cancer, breast cancer and cancers of the uterus which includes endometrial cancers.

Figure 7: Top 5 Female Cancer Site for 2011


2 9

Figure 8: Top 5 Male Cancer Sites for 2011

40

27

17 16 13

0

5

10

15

20

25

30

35

40

45

Unknown Primary Sites Prostate Liver Skin Esophagus

Num

ber

of C

ases

Cancer Sites

Top 5 Male Cancer Sites, 2011

Source: Cancer Registry, 2011

Apart from unknown primary sites, liver, prostate, skin and esophageal cancer were the most common cancer sites among males.

6.1.3 Cardiovascular Diseases

Figure 9: Top 3 Cardio Vascular Disease conditions for 2011

524 453

316

0

100

200

300

400

500

600

Congestive heart failure Essential (primary)hypertension

Unstable angina

No.

of C

ases

Disease

TOP 3 CARDIOVASCULAR DISEASES CONDITIONS FOR 2011.

Source: Ministry of Health, HIU

Figure 8: Top 5 Male Cancer Sites for 2011

Figure 9: Top 3 Cardio Vascular Disease conditions for 2011


3 0

6.2 Communicable Disease

The Fiji Centre for Communicable Disease Control Laboratory at Mataika House also designated Public Health Laboratory (PHL). National Influenza Centre by WHO, National Measles Laboratory by WHO consists of few sections that perform an array of public health testing activities and cultivates public and private partnerships at local, national, subregional and at international level. During FY 11 the laboratory performed approximately 4-5,000 tests on clinical samples to detect sero-diagnostic for dengue, measles, rubella and HIV anti-virus and zoonotic leptospirosis from clinical samples. Molecular, real-time polymerase chain reaction(RT-PCR) for Influenza and bacterial contaminants in water for threats to human health; screened 692 suspected rubella cases and confirmed 140 cases around august to October 2011 rubella outbreak. Moreover all the 692 samples were also screened by Measles Enzyme Immunoassay to remove dought for a positive measles co infections. Towards the 4th quarter of FY11 initiative taken to enhance vaccine preventable diseases (VPD) testing to support its surveillance in relation to the global initiative of the eradication of Polio and measles in Fiji.

In FY 11, the Virus Laboratory continue to strengthened network with Labasa (Northern), Lautoka (Western) and CWM Hospital (Central/Eastern) on communicable diseases testing. Data at divisional level to be collaborated in terms of confirmation and routinely reported to Mataika House to be analysed by the surveillance unit and to support Ministry of Health evaluation of communicable diseases control.

6.2.1 Typhoid

Figure 10: Typhoid Cases for 2011 by months

47 50

33 29 26 29 31 27 29 24

41 38

Typhoid cases for 2011 by months 2011

Source: Laboratory confirmed Data from Mataika House

February recorded the highest number of cases (n 50, 12%) for the year 2011. Case counts fluctuated between 33 to 26 cases for the months that followed before a peak was noted for November (n 41, 10 %) and for the last month slighlty cases decreased. The age group most affected were those in the 20-29 age group.

Figure 10: Typhoid Cases for 2011 by months


3 1

6.2.2 DengueFigure 11: Dengue cases for 2011 by months

1

4 5

2

6

11

8 8

1

10 11

02468

1012

Case

cou

nts

Months of Onset

Dengue cases for 2011 by months 2011


Data available allowed valid discussion to be made only with the 2011 dengue cases as there were only two positive cases recorded for the year 2010. For 2011, the highest number of positive cases recorded was for the month of June and Dec (n 11, 16 %). The next significant peak noted was for the last two months ofNovember (n 10, 15%).

Major outbreaks of Dengue were noted in 2002-2003 period and 2008-2009 period. The incidence of Dengue ranges between 0.1-80 per 100,000 population. Outbreaks have been noted every 5-8 years. Some of the significant outbreaks of Dengue in Fiji occurred in : 1971, 1975, 1989-1990, 1998, 2002-2003 and 2008-2009. In 2011 a total of 111 cases were reported, mainly from the Western Division.

6.2.3 Leptospirosis

There were more cases noted in 2011 compared to 2010. June recorded the highest counts of 28 cases and these were reported from the following medical areas; Suva, Labasa, Tavua, Vunidawa and Wainibokasi. Cases declined for the preceding months but increased in the last month of the year. 2010 Leptospirosis cases peaked the most in April (n 18, 24%) and the number documented for the remaining of the year also declined.

Figure 11: Dengue cases for 2011 by months


3 2

Figure 12: Leptospirosis cases for 2011 by months

3

12 7

14 18

28

11

4 2 0 4

14

05

1015202530

Leptospirosis cases for 2011 by months

2011


6.2.4 HIV

Figure 13: HIV new cases from 1989 to 2011

1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

New Cases # 4 3 3 4 3 6 8 4 4 7 12 10 17 26 31 29 29 36 23 31 43 33 53

0

10

20

30

40

50

60

New

Cas

es

HIV New Cases from 1989 to 2011


Figure 12: Leptospirosis cases for 2011 by months

Figure 13: HIV new cases from 1989 to 2011


3 3

6.2.5 Tuberculosis (TB)

Figure 14: TB indicators by Division for 2011

050

100150200250

Num

ber o

f Cas

es

Indicators for TB

TB Indicators by Division, 2011

Central

Northern

Western

National

Source: National TB Programme [NTP]

In 2011 a total of 213 cases of TB were reported giving a case notification rate of 24.33 per 100,000 population. There were a total of 3 relapse cases and 5 retreatment cases after default. Pulmonary TB accounted for 81% and Extrapulmonary 19% of the total TB cases. There were roughly equal proportions of smear positive (51%) and smear negative (49%) cases reported. A total of 3 TB-HIV co-infected patients reported mainly from the Central Division.

Figure 14: TB indicators by Division for 2011


3 4

6.3 Maternal Child Health

Figure 15: Under 5 Mortality Rate for Fiji, 1969-2011

Source: Ministry of Health Annual Reports 1990 - 2009; Statistics from Health Information Unit at MOH 1960 - 1984

There has generally been a declining trend in the under five mortality rate over the past 50 years. A steady decline was noted from about 75 per 1000 livebirths in the 1960s to about 21 per 1000 livebirths in 1990. Thereafter, the rate has on average been around 23 per 1000 livebirths over the past 20 years. The target for 2015 is 9.2 per 1000 livebirths, which means a reduction by 57% is still required.

Figure 16: Maternal Mortality Ratio for Fiji,2000-2011

Source: Maternal Mortality Database, Ministry of Health

Figure 15: Under 5 Mortality Rate for Fiji, 1969-2011

Figure 16: Maternal Mortality Ratio for Fiji,2000-2011

Source: Maternal Mortality Database, Ministry of Health


3 5

The Maternal Mortality Ratio has been fluctuating between 22 and 58 per 1000 livebirths over the past 10 years. However, it is important to note that even one maternal death can dramatically change the maternal mortality ratio. There were 8 maternal deaths in 2011 compared to 5 in 2010.

Figure 17: Contraceptive Prevalence Rate for Fiji (per 1000 CBA)

Source: Public Health Information System, Ministry of Health

The contraceptive prevalence rate has been ranging between 29% to 49%.

Figure 18: Percentage of 1 year olds Immunised Against Measles, 2000-2011

Source: Public Health Information System, 2000-2011, MOH The immunisation rate for measles has been ranging between 68 and 98% over the past 10 years. Whilst

the rate reported through the Public Health Information System has consistently been about 71% in 2009 and 2010, the coverage surveys have shown higher rates (e.g. 94% in 2008), suggesting the need to improve routine reporting.

Figure 17: Contraceptive Prevalence Rate for Fiji (per 1000 CBA)

Source: Public Health Information System, Ministry of Health

Figure 18: Percentage of 1 year olds Immunised Against Measles, 2000-2011

Source: Public Health Information System, 2000-2011, MOH


3 6

SECTION 7.0:Public Health Promotions

In 2011, the National Centre for Health Promotion (NCHP) team had identified four strategic approaches to addressing the revitalization of the National Centre for Health Promotion functions. The strategies included;

Reviewing of current processes and its effectiveness Refining Health Promotion Programs to meet targets Re-orient Health Promotion & Public Health Delivery Service; and Respond accordingly

In undertaking the above, the NCHP in 2011 clearly delineated the Strategic Priority Areas that addressed the Strategic direction of the Ministry of Health. Focus was positioned on the risk factors for Non- Communicable Diseases, Communicable Diseases and Mental Health. The risk factors are the common target intervention areas which the National Centre for Health Promotion as every year has focussed its resources and strength on.

As per the risk factors, health promotion priority areas were identified and interventions at different levels were developed and implemented.

7.4.1 Policy Interventions

Building healthy public policy combines diverse but complementary approaches to government actions including legislations, fiscal measures, taxation, guidelines designed to promote health. Health Promotion policy has been in effect at the settings level and within government policy level, local community policy development will continue to be encouraged through the COD settings approach. The policy developed over the years needs to be reviewed on its implementation level, short falls and gaps which need to be refined and re-addressed. The following activities were undertaken.

Table 18

Scope work on the proposed establishment of National Health Commission (NHC)

Scope work on the proposed establishment of National Health Commission (NHC) completed by WHO consultant.

Consultant Report submitted to Minister for Health

NHC to be reflected in the PH Act Review currently under review.

NHC toned down to advisory committee status to be implemented in 2012

A scope work was done on Development of a Fiji Plan for Physical Activity(FPAPA)

A scope work was done on Development of a Fiji Plan for Physical Activity(FPAPA)

The first stakeholder workshop was conducted in Suva on and a follow up consultation will be done in 2012

A second round stakeholders workshop will be conducted in February 2012

Table 18


3 7

7.4.2 Social Marketing

The Social Marketing aspects of the Operational Plan are built on the Strategic Health Communication Model while expanding through to the setting approach as point of service. The Social Marketing Operations are interlinked with other elements of the Operational plan. Social Marketing is the process of applying basic (commercial) marketing techniques to social issues in order to create behavior change (Kotler and Anderson). The Consumer or the target population is the central focus for all steps of a social marketing campaign. Therefore, Social Marketing is “a consumer based approach that helps program planners identify ideas, create messages, change practices and develop products that will stimulate people to adopt a better healthy behaviour.

Priority Social Marketing campaigns implemented

Table 19

Activity Carried Out Remarks SHC ACTIVITIES SHC Training for all senior Health Staff March 21-25 SHC Campaign Action Against Anemia (AAA) SHC plan launched at MOH HQ by Minister

for Health and Minister for Agriculture Mr Jokatani Cokanasiga on 22nd July 2011

Obesity Prevention In Children (OPIC) Program handed over to MOH for continuation

Oral Health First phase survey completed and to commence as detailed in the plan

Expanded program for Immunization(EPI) Immunization program has been launched and is undergoing its various phases.

7.4.3 Evidence Based Decision Making

Research is the systematic analysis and interpretation of data to answer a certain question or solve a problem. The officer has been seconded to WHO and therefore the position was vacant and this was an area of concern that there was no officer to do the research at NCHP which will be filled in 2012. The unit has been conducting pretesting of IEC materials as most IEC at the Centre were outdated and responsible program Officers were notified to review the objectives of the IEC. An evaluation of the move for health was done in April 2011 in Suva and the findings are:

Research on Walk For Health – 02nd April, 2011

The graphs that follow show the number of people that turned up for the first walk of 2011. Graph 1 shows the different age groups while graph 2 shows the number between the genders.


3 8

Results of the National Health Walk: 2nd April, 2011.

Table 20 Status Frequency

Normal 51

Obese 18

Overweight 30

Underweight 9

Total No. Screened 108

Figure 19

Series1, Normal , 51, 47%

Series1, Obese , 18, 17%

Series1, Overweight , 30,

28%

Series1, Undeweight , 9,

8%

Overall Status

Table 20

Figure 19


3 9

Figure 20: Status by Gender

Female Normal

25

Female Obese

12

Female Overweight

18

Female Undeweight

7

Male Normal

26

Male Obese

6

Male Overweight

12

Male Undeweight

2

Status by Gender

7.4.4 Community and Organizational Development

The NCHP operational plan needs to maintain and expand on the approach to health promotion focusing on settings approach and seeks maximum community involvement in designing and implementation of HP activities. The healthy Cities Movement in 1987 began the approach of applying multisectoral actions within identified settings. The Healthy Island concept was formulated to complement the Healthy City movement approach through settings where we live, work and play such as villages, settlements, workplace, schools and now focusing on the island approach. As of 2008 figure Fiji has 473 HP Community settings, 171 in the North, 66 settings in the West, 236 in the Central Eastern. To date only the Central/ East Division has a functional divisional Unit in place and still funded by Fiji Health Sector Improvement Program (FHSIP). The Northern and Western Division remains vacant. The Centre will need to strengthen capacity at the Divisional and sub divisional level to once again take the leading role in HP Community Program.

Figure 20: Status by Gender


4 0

SECTION 8.0: Environmental Health & Nutrition

8.1 Environmental Health

The Environmental Health (EH) department continued to be devoted to protecting and improving the health of Fiji’s population by limiting their exposure to biological, chemical and physical hazards in their environment. The EH department was guided by the EH business plan and done in alignment with the Ministry of Health’s Strategic Development Plan. This included the EH commitments such as review of the Public Health Act, the Food Safety Bill , Quarantine Act and amendments to the National Building Code. The National Environmental Health Plan (NEHAP) was aligned to the strategic plans of the Ministry.

The department is mandated by law, empowering the Central Board of Health to the Urban and Rural Local Authorities to oversee activities through the following key areas, in surveillance and compliance . The legislations include the Public Health Act, Food Safety Act, Quarantine Act, Burial Cremation Act, Town Planning and Environmental management Acts.

Activities undertaken in 2011 by the department included:

• Public Health Act review – an internal committee has been formalized to look into the review of the PH Act. The Committee consists of DSPH, representative from the Solicitor General’s Office, NANCD, NA Family Health, NAEH, SHI WM/PC/EM Secretariat, Officer in charge Tobacco Control Unit, Media Liaison Officer – MoH

• National Building Code and Quarantine Act review

• Health facilities audit – the EHOs are engaged in auditing all health facilities around Fiji to assess the condition of these facilities.

• Health Care waste training and audit – training was conducted for waste in all divisions. The unit has also been tasked with securing consultants to draw up safety procedures for medical waste.

• Online registration – to improve and streamline building and sub-divisional applications the unit has commenced works to develop a database. Training was organized by ITC and attended by Suva Health Office and CBH staff.

• Development of Standard Operating Procedures

2011 noted improvements in the areas of sanitation, food quality, pollution and waste management, health education, development control and vector control.

Table21: Distribution Of Local Authority and Health Offices by Division


4 1

Facility Divisions Under CBH

On Study Leave

Total Central Western Northern Eastern

Local Authorities 4 6 4 2 16 Environmental Health Officers

28 47 19 8 7 2 111

Staff/ Population Ratio 1: 6,000 - - 1: 4,911

Table 22 : Surveillance of Sewage and Wastewater Disposal

Divisions No. of H/Hold in the District

No. of Inspections

Sewage System

Septic Tanks

Water Seal

Pit None Noticed Served

Western 31558 27970 494 17691 7849 3341 635 3 Central 1993 391 51 1070 917 724 10 332 Eastern 2,777 226 0 768 443 5 3 1 Northern 9,257 7,248 126 3,337 3,206 547 478 300 Total 45,585 35,835 671 22,866 12,415 4,617 1,126 636

Table 23: Inspection of Drinking Water Supply

Divisions No. of Households

No. Inspected

Piped Water

Ground Water Source

Surface Water

Rain Water

Western 27,697 19,492 7,766 1,120 611 93 Central 47,921 321 1,865 41 60 53 Eastern 2,736 229 1,958 18 0 6,140 Northern 8,873 3,907 3,345 388 1,913 5,966 Total 87,227 23,949 14,934 1,567 2,584 12,252 8.2 Nutrition

The Dietetics and Nutrition Services is an integral component of health services in the country. Increase in life expectancy of 37 years is attributed to 80% Nutrition and only 20% to modern medicine. (Wootton, 2008). The aim of the Dietetics and Nutrition Services is to improve the nutritional status of the population in Fiji.

The services provided both curative and preventative and include the following: - Food Service Management - Clinical Dietetics - Public Health Nutrition

Food Service Management is the provision of nutritionally adequate meals, dietary management of patients and complements the total recovery of patients. For 2011, the Food Service Management had a budget of $1.5 million. Clinical Dietetics includes nutritional assessment and counselling, dietary modifications and therapeutic diets for individual patients and nutritional promotion activities within Hospitals and Institutions. The Public Health Nutrition with the coordination and implementation of all nutrition activities in the Division and Communities has the FPAN as its guiding document.

Diet and Nutrition are also important risk factors for the prevention, management and control of Non-Communicable Diseases. The Dietetics and Nutrition Services focuses on the achievement of MDG’s 4 and 5, Baby Friendly Hospital Initiative implemented and maintained in all hospitals and Infant and Young Child Feeding Practices coordinated in all health care facilities. The Ministry of Health is conducting a national program, the National iron and micronutrient supplementation [NIMS], as a preventative measure to reduce anaemia and vitamin A deficiency in young children.

Table 22 : Surveillance of Sewage and Wastewater Disposal

Table 23: Inspection of Drinking Water Supply


4 2

The provision of Vitameal as this will address the issue of undernourished children in Fiji. Nuskin is supplying free vitameal to the children in Fiji as part of their “Feed the Children Initiative”. Fiji received 2 consignments in 2011.

Milk Supplementation Program is the provision of milk powder to supplement the diets of the moderate to severe malnutrition cases who come from disadvantaged families and attending the Non Thrivers Clinics.

Food Voucher is a Government incentive, $30.00 per Clinic visit for expecting mothers in rural areas to utilize their rural health centres and go for early bookings.

This is to note that steps are taken by the Ministry of Health, focussing on the promotion of optimal nutrition and prevention of nutrition related diseases example Non Communicable Diseases and micronutrient deficiencies, and the concept of Wellness to the people of Fiji.


4 3

Table 24 Activity Date No. Trained

CentEast Health - IYCF Training (Central)

- IYCF Training (Central/Eastern)

- March - June

24 45

CWM Hospital - 18 hours BFHI workshop - Food Handling & Hygiene Training - CWMH Korovou Outreach - -Communication Technique - -Infant Young Child Feeding - -Continue Nutrition Education - -Infant Young Child Feeding - -CWMH Vunidawa Outreach - -Infection Control Training - -New Growth Chart Training - -Nutrition Month celebrations - -Nutrition month activities - Herbs Garden - Nutrition Presentations - Nutrition Education presentation/talks - NCD Month - Community Outreach-SNAP - Dietitians CNE

-Jan & Feb -Feb -April -April -May -May -May -May -June -June -August -August October 12/10/11 November

-2days -2days -2days -5days -3days -2days -5days -2days -5days

Western Health IYCF Training Western Breastfeeding Committee meeting 18 hrs BFHI training per subdivision NCD step survey 2012 Code Monitoring training

02 – 06 May & 07 – 11 Nov 11th March May 17th-30th June 17th-18th June

42 18 10-15 25

Lautoka Hospital - Trainings : - In service for Cooks

- In service for Cooks - Child Growth assessment

- IYCF - 18 hrs BFHI - Induction - OHS - Audit - Disaster management - Meeting : - Unit meeting - HODs meeting - Clinical meetings - Surveys : - Plate waste - Patient Meal satisfaction

23/02/11 30/03/11 1/4 -3/4 2/5 – 6/5 11/5-13/5 9/5/11 6/6-10/6 Monthly Quarterly 2nd Quarter

7 cooks 8 cooks 1 Dietitian

Northern Health Advocate Healthy school lunches and physical activities in schools

1st Quarter

40 preschools

Table 24


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Table 26: Primary Schools

Tot. Roll Tot. Assessed

Severe U/Wt. (%)

Mod. U/Wt. (%)

Normal (%)

O/Wt / Ob. (%)

Central Health 46553 34120 586 (2%)

4716 (14%)

25517 (74%)

3301 (10%)

Eastern Health 4167 3981 32 (1%)

273 (7%)

3169 (79%)

507 (13%)

Western Health 38152 35620 3294 7367 20419 4540

Northern Health 17419 16627 525 (3%)

1883 (11%)

11787 (71%)

2432 (15%)

TOTAL 68139 54728 1143 6872 40473 6240

Table 25: Pre-Schools


Severe U/Wt. (%)

Mod. U/Wt. (%)

Normal (%)

O/Wt / Ob. (%)

Central Health - - - - - -

Eastern Health - 60 0 3 (5%)

51 (85%)

6 (10%)

Western Health 3331 2573 320 617 1414 222

Northern Health 863 738 20 (3%)

50 (7%)

608 (82%)

60 (8%)

TOTAL 863 798 20 53 659 66

8.2 School Health: Nutritional Status

Table 25: Pre-Schools

Table 26: Primary Schools


4 5

Northern Health Advocate Healthy school lunches and physical activities in schools School visits Move for Health once/month/SubDiv Nutrition promotion-Bula 5:30 ; Fruits&water day once/week for Govt Institutions Inhouse training for all kitchen staffs in Sub-Div. Hospital Meal Satisfactory Survey

- BFHI and IYCF trainings for Health Staff and Community

Health Workers - Nutrition Month - World Food day - NCD month - Hospital Gardens

= Taveuni Hosp. - $13 897.00 = Savusavu Hos. - $1 986.60 = Nabouwalu - $567.12 = OPH Labasa - $2 672.84 = TOTAL - $19 124.26

User Friendly Meal Service in Sub-Divisional Hospital

1st Quarter

2nd Qrt.

May June June August

October November

40 preschools 123 primary schools

-7 secondary schools

49 walks done

66% coverage

Table 29: 1st Phase: Primary School Phase Tot. Roll Tot. Treated % Treated

Eastern Health - Kadavu 2,204 2,204 100% - Lakeba 681 681 100% - Vanuabalavu 359 359 100% - Rotuma 389 344 88.4% - Lomaiviti 947 947 100% Central Health - Rewa 4445 4445 100% - Tailevu 1273 1265 99.4% - Naitasiri 2476 2476 100% - Navua 3 142 2 991 95% - Suva 16 134 11 190 69.4% Western Health - Nadroga/Navosa 5971 5959 99% - Nadi 10462 10122 97% - Lautoka/Yasawa 12787 11103 87% - Ba 6075 6075 100% - Tavua 3070 3045 99% - Ra 4700 4590 98% Northern Health - Cakaudrove 6 588 6 550 99% - Bua 2 933 2 881 98% - Macuata 10 043 9 513 95% - Taveuni 3 211 2 155 67% TOTAL 89874 80779 89.90%

8.3 National Iron & Micronutrient Supplementation (NIMS):

Table 29: 1st Phase: Primary School Phase


4 6

Table 27: Secondary Schools


Severe U/Wt. (%)

Mod. U/Wt. (%)

Normal (%)

O/Wt / Ob. (%)

Northern Health 300 (CBA’s Only)

288 0 21 (7%)

156 (54%)

111 (39%)

TOTAL 300 288 0 21 156 111

Table 28: School Gardens

Tot. No. of Schools

No. with Existing Gardens

No. with New Gardens

No. with School Canteens

Remarks

CentEast Health 75 25 Nil 20 Only 1-Dietician

Northern Health 119 82 8 26 Only 1-Dietician

Western Health 245 139 9 185 20% sell <25% junk 29% sell 25-50% junk 27% sell > 50% junk

TOTAL 439 246 17 231 Need school Dietician

Table 27: Secondary Schools

Table 28: School Gardens

Table 30: 2nd Phase: Maternal Child Health

` 2009 Total Live births

Overall Coverage (%) Tot. Treated

Eastern Health - Kadavu 161 46.6% 75 - Lakeba 53 100% 53 - Vanuabalavu 57 N/R N/R-Cicia - Rotuma 3 100% 3 - Lomaiviti 163 0% Staff shortage Central Health - Rewa 584 5.13% 30 - Tailevu 299 8.36% 25 - Naitasiri 73 100% 73 - Navua 418 11.96% 50 - Suva 3784 1.98% 75 Western Health - Nadroga/Navosa 641 15% 94 - Nadi 1097 6% 66 - Lautoka/Yasawa 1252 8% 98 - Ba 568 8% 44 - Tavua 338 16% 52 - Ra 404 18% 271 Northern Health - Cakaudrove 302 71.5 % 216 - Bua 156 36.5 % 55 - Macuata 1315 23.19 % 415 - Taveuni 266 20.67 % 78

Table 30: 2nd Phase: Maternal Child Health


4 7

8.3 Milk Supplementation ProgramTable 31

Overall Coverage (%) Tot. Treated Eastern Health - Kadavu 3% 12 - Lakeba 4% 15 - Vanuabalavu 2% 8 - Rotuma 3% 10 - Lomaiviti 5% 24 Central Health - Rewa 15% 48 - Tailevu 25% 68 - Naitasiri 34% 70 - Navua 31% 40 - Suva 19% 55 Western Health - Nadroga/Navosa 14% 59 - Nadi 7% 54 - Lautoka/Yasawa 19% 37 - Ba 55% 109 - Tavua 31% 32 - Rakiraki 31% 48 Northern Health - Cakaudrove 13% 216 - Bua 7% 55 - Macuata 17% 415 - Taveuni 9% 78 TOTAL

8.4 Child Health: Nutritional Status

Table 32

Overweight Normal Mild U/Wt Mod. U/Wt Sev. U/Wt 0 - <1yr

1 – 6 yr

0 - <1yr

1 – 6 yr

0 - <1yr

1 – 6 yr

0 - <1yr

1 – 6 yr

0 - <1yr

1 – 6 yr

Central Health 5335 1094 11039 4003 1631 747 257 102 27 3

Eastern Health 282 461 1064 1531 1602 1700 8 15 0 0

Northern Health 1140 281 2542 1005 320 292 16 23 4 15

Western Health 1607 405 3868 1798 2057 1827 516 608 103 89

TOTAL 8364 2241 18513 8337 5610 4566 797 748 134 107

Table 31

Table 32


4 8

Maternal Health: Hb

Table 33

Hb ≥ 11.0g 9.0 – 10.9g 7.0 – 8.9g ≤ 6.9g Total

CentEast Health 293 218 31 5 547

CWM Hospital 474 270 229 134 1107

Lautoka Hospital 884 603 89 1 1577

Northern Health - 575 35 - 610

Western Health 3050 733 74 14 3871

TOTAL 4701 2399 458 154 7712

8.5 In-Patients: Nutritional StatusTable 34

UNDER WT. (%)

NORMAL (%)

OVERWEIGHT (%)

OBESE (%) TOTAL

CWM Hospital 20 46 34 18 118


Northern Health 66 931 401 130 1528

Western Health 125 475 201 455 1256

TOTAL 344 1792 1051 791 3978

% 9% 45% 26% 20%

8.6 Out-Patients: Nutritional Status

Table 35 UNDER WT. NORMAL OVERWEIGHT OBESE TOTAL

Eastern Health 9 190 219 354 772

Central Health 118 963 1196 1523 3800

NDC 0 73 196 187 456

CWM Hospital 6 332 - - 338


Northern Health 462 1214 532 239 2447

Western Health 586 2460 2116 2264 7426

948 4043 3054 3216 11261

% 8.4 36 27 29

Table 33

Table 34

Table 35


4 9

SECTION 9.0: ORAL HEALTH

The department of Oral Health provides preventive and curative services at primary, secondary and tertiary levels. Their activities range from oral health promotion to complex oral surgery. There are approximately 180 oral health staff who provide services in 30 health facilities nationally. The team vision is: “enhanced quality of life of all people in Fiji through improved oral health” through a mission statement of: “to provide quality healthcare services within an enabling environment, delivered by adequately trained and skilled personnel with the involvement of stakeholders for the attainment and maintenance of good oral health”

Table 36: Dental Statistics 2009 2010 2011 % Δ 2010/2011 Total attendees (static clinic)

161 899 160 344 104 041 35% decrease in attendance

Total revenue ($)

312 549 308 326 735 443 139% increase in revenue collected

Total Conservative Treatment

43 559 39 448 29 152 26% decrease in treatment

Total Preventive procedures

67 540 70 546 72 559 3% increase in treatment

Total treatment done in schools

50 840 86 014 46 196 46.3% decrease in treatment

Highlights for the oral health department:

• The revised dental charges under the Public Health & Dispensaries (Amendment) Regulations 2010 resulted in higher costs imparted to patients and a 54% decrease in attendance. Patients are presenting late resulting in fewer preventive and conservative treatments imparted to them.• The 2011 National Oral Health Survey was carried out after a period of seven years to assess the current oral health status of the population.• The Trade Standard (Toothpaste Standard) Order 2011 was adopted and outlines the availability of fluoridated toothpaste in Fiji. Cabinet granted approval after extensive consultations with relevant stakeholders and on the recommendation of the Honourable Minister for Health.• The national fluoridation of water supplies has been implemented with the cooperation of the Water Authority of Fiji (WAF). The initial phase was commenced at the Wailoku treatment plant with a roll out to other reticulated water supplies in Suva.• The oral health services joined the divisional Specialist Outreach programmes to the rural and maritime areas.• Oral health promotion programmes continued to be strengthened with all clinics conducting trainings with village Health Workers, teachers and parents to promote good oral practices. The National • Oral Health Week was launched in Vuna Village, Taveuni with community involvement.• The oral health unit continued to promote private public partnerships with organizations like Colgate and the Bank of the South Pacific to take services to the needy and marginalized communities in rural, peri-urban settlements and villages.• An internal audit was carried out to efficiently manage stocks and ensure optimal stock control• The Office of the National Advisor Oral Health was relocated to the Colonial War Memorial Hospital Dental Clinic and reclassified as Chief Dental Officer – CWMH during the month of August.

Table 36: Dental Statistics


5 0

• The dental unit was successfully able to respond to the SFCCO requirements on the two KPI’s: • 30.2.2.1 Implement Oral Health Promotion programmes • 26.1.1.4 Exemption of dental fees for children under 15 years of age

• The CWMH dental clinic was reopened in March after undergoing three months of refurbishment and upgrading. The generosity of the Bank of the South Pacific enabled the patient waiting room to be renovated.

• The oral health unit prepared a submission to the Public Service Commission for a review of the human resource status in the oral health department, based on the demand for oral health services, service specialities, increased populations and the need for more officers.

• The dental unit received thirteen new units for various clinics around the country.


5 1

SECTION 10.0: RISK MANAGEMENT

10.1 Sentinel Events

It is now well known that medical errors occur in all healthcare systems world-wide. Even though healthcare is provided by highly trained, hardworking, intelligent and dedicated professionals, errors are still uninten-tionally committed that can result in medical harm or death to patients.

In response to this the MOH has invested significant financial resources through the establishment of Risk Managers to facilitate patient safety programs in each of the three divisions to enhance the development and implementation of systems and processes to drive the improvement of quality and safety in healthcare.

The Risk Management program with its clinical incident management program is well established and is firmly embedded in the clinical governance framework of the ministry. In addition a systems approach has been adopted which includes a culture of learning from mistakes to improve patient safety, as opposed to interrogation and blaming individuals for errors to improve reporting of sentinel events.

The total number of sentinel events reported from hospitals and community health facilities was twenty eight (28) for the year 2011. Twenty eight (28) RCA investigations were undertaken and arising from the investi-gations were seventy nine (79) recommendations of which 87% of the RCA recommendations were imple-mented.

The leading category of sentinel events was in relation to complications to emergency care and hospital pro-cess issues such as delayed referral. This was followed by maternal deaths.

Table 37: Notified & Confirmed Sentinel Events for the Divisions & Sub divisional Hospitals including % of Events that resulted in Death for 2011

Table 37: Notified & Confirmed Sentinel Events for the Divisions & Sub divisional Hospitals including % of Events that resulted in Death for 2011

Hospital/ Facility N0. Of

Sentinel Reported

N0.RCA investigations undertaken

No. of Sentinel Events that resulted in Deaths

N0. of Recommendations arising from RCA reports

No. of Recommendations Implemented

CWM Hospital 0 0 - - -

Labasa Hospital 1 1 0 4 0

Lautoka Hospital 10 10 10 21

100%

Sigatoka Hospital 1 1 1 4 100%

Tavua Hospital 2 2 2 6

100%

Ba Mission Hospital 1 1 1 4 100%

Nadi Hospital 1 1 1 4

100%

Rakiraki Hospital 1 1 1 2 100%

Korovou Hospital 1 1 1 5 90%

Levuka Hospital 1 1 1 2 100%

Nausori Health Center 1 1 1 3 100%

Taveuni Hospital 6 6 6 19 74%

Vuna Health Center 1 1 1 3 70%

Savusavu Hospital 1 1 1 2 100%


5 2

Table 38: Category of Sentinel Events Reported in 2011

Category of Sentinel Event

Lautoka Hospital

CWM Hospital

Labasa Hospital

WHS NHS C/East HS Total

Complication on Emergency Management

1

- - 2 2 3 8

Maternal Death 3

-

- 2 2 - 7

Fetal Complication of delivery (including neonatal death)

0 - - - 1 - 1

Hospital process issue (eg; failure to access timely & assess timely and appropriate care given, poor planning).

3 - 1 2 2 - 8

Complications of surgery (including post-operative death

3 - - - - 3

10.2 Contributing Factors

Contributory factors are actions (or root causes) that have played a role in the development of anincident or increased occurrence of a risk. In reference to the leading incident type, Treatment/Test/Procedure, the most common contributory factors were caused by the lack of knowledge and skills, procedures not being followed and unavailability of procedures.

During the process of an RCA investigation, contributory factors are identified and RCA recommendations are developed to address them to prevent a similar incident from occurring. Contributory factors are actions (or root causes) that have played a role in the development of an incident or increased occurrence of a risk therefore Reports on contributory factors are essential because they identify the causal elements that allowed an incident to occur.

In reference to the leading incident type, Treatment/Test/Procedure, the most common contributory factors were caused by the lack of knowledge and skills, procedures not being followed and unavailability of procedures.

This was followed by Policy/ Procedure; the contributory factors were related to unavailability of policy and staff not following policy. Documentation contributory factors were related to insufficient documentation and Equipment contributory factors were related to equipment not available.

Communication contributory factors were all due to insufficient communication between clinicians. Delay in Process contributory factors was related to delays in referral and general staffing issues. Lastly, issues related to oxygen, nutrition and Infection control were all one off situations.

Table 38: Category of Sentinel Events Reported in 2011


5 3

10.3 Principal Incident Types

Each of the 79 recommendations was classified by a principal incident type based on the Ministry of Health Unusual Occurrence reporting form. Of the 26 principal incident types on the Unusual Occurrence reporting form, a total of six appeared most frequently. They were: Treatment/Test/Procedure; Policy or Procedure, Equipment, Documentation Communication, and Delay in Process.

The leading principal incident type identified in the RCA recommendations were Treatment/Test/Procedure followed by Policy or Procedure. Documentation and Equipment was followed by Communication and Delay in Process.

Frequency of these incident types is displayed below:

Figure 21: Principle Incident Type

10.4 Quality Improvement

There has been significant quality improvement processes put in place from RCA recommendations. We are constantly reviewing standards of practice, up skilling of clinicians, capacity building at all levels to ensure the quality of care for patients is optimized with reduced risk to patients, visitors and staff.

Follow up processes of RCA recommendations have now standardized and have been introduced in 2012 to ensure improved rates of implementation of RCA recommendations. In addition, all RCA reports are forwarded to the principle administrator health systems standards for editing, monitoring and evaluation follow up.

Sources for RCA investigations: • Clinical Indicators • Reported clinical incidents • Morbidity &Mortality meetings • Quality Assurance • Clinical Audit • Point Prevalence Survey

Figure 21: Principle Incident Type


5 4

SECTION 11.0: Climate Change

The Piloting Climate Change Adaptation To Protect Human Health Project (PCCAPHH) project aims to strengthen the capacity of the health sector to respond effectively to climate-sensitive communicable diseases like dengue and typhoid fever, leptospirosis and diarrhoeal illnesses, especially outbreaks following hydrometeorological disasters like floods and droughts.

The overall goal for 2011 was to undertake multi-disciplinary climate-sensitivity analysis to identify areas most vulnerable to the climate impacts on health. Results show that different diseases have different sensitivities to climate conditions in different locations in Fiji. Full results can be found in the “Climate-Sensitive Infectious Diseases in Fiji: 2011 Summary Report of the PCCAPHH Fiji project”.

In summary, in the Bua, Ba and Suva sub-divisions, diseases are the most sensitive to average climate conditions (e.g. rainfall, maximum temperature, minimum temperature and humidity) with lags of one or two months. In other words, disease outcomes are determined by climate conditions in preceding months. For example, in the Bua sub-division, monthly dengue cases rise after average minimum monthly tempera-tures are sustained over 240C for two months, as shown in Fig. below.

Figure 22: The threshold effect of Minimum Temperature on Dengue in the Bua Sub-Division

05

1015

deng

ue

21 22 23 24 25tmin2

bandwidth = .8

Lowess smoother


5 5

Thus, the project has established statistically significant relationships between the diseases and climates in various sub-divisions in Fiji.

In addition to the climate-sensitivity analysis, the Epidemiologist and some staff at the Centre for Communicable Disease Control were trained to use STATA, a software for statistical analysis. Geographical Information System (GIS) software was also installed in these units. Partnerships were built with the Fiji Lands Department for GIS capacity building and the Fiji Red Cross for implementation of health adaptation activities in vulnerable communities. Health and other sectors were sensitized, at various fora, about the impacts of climate change on human health. The PCCAPHH project also contributed to the development of Fiji’s National Climate Change Policy.

SECTION 12.0: Human Resource Management and ResearchThe following is the staff establishment for the MoH for 2011:

Table 39 : Staff Establishment Status as at 31/12/2011Table 39 : Staff Establishment Status as at 31/12/2011 Cadres 2011

Approved No.

No. Filled No. Vacant

Medical Officers [MD01 - MD06] 425 353 72 Medical Assistants [MD07] 9 6 3 Nursing [NU01 – NU06] 2056 1941 115 Orderlies [NU07 – NU08] 71 58 13 Dental Officers [DE01- DE03] 51 49 2 Para-Dental [DE03 – DE04] 150 132 18 Laboratory Technicians [HW02 – HW07] 130 121 9 Radiographers [HW02 – HW06] 67 60 7 Lab/Xray Assts [HW06] 10 7 3 Physiotherapists [HW02 – HW06] 35 34 1 Dieticians [HW01 – HW06] 56 46 10 Pharmacists [PH01 –PH05] 86 62 24 Environmental Health [HW01 – HW06] 119 111 8 Administrative Staff [SS01 – SS05] 162 122 40 Accounting Staff [AC01 – AC04] 20 15 5 Secretary/Typist [SS03 – SS05] 52 36 16 Telephone Operator [SS05] 10 8 2 Statisticians [SS02 – SS05] 13 9 4 Information Technology Staff [IT03 – IT07] 9 6 3 Stores Officers [SK01 – SK05] 31 21 10 Upper Salaried Staff [US01-US04 & HR02] 17 13 4 Bio-Medical Staff [ES02 – ES06] 10 5 5 Other Classifications* 41 21 20 Established Staffs Total 3,630 3,236 394 GWE Staffs Total 1,294 849 445 OVERALL TOTAL 4,924 4,085 839

*Other classifications include HR/US(HQ), SS (Info, Officers) Librarians (IR), TG cadre, Bio-Med(ES) and others.

12.1 Industrial Relations department reportFor the year 2011, the Ministry received a total of 82 cases of which 75 were closed and the remaining pend-ing cases were with PSC, FICAC and MoH.

Table 40 Number of Case received 82 Pending Cases 4 FICAC Case 3 Number of Closed Case 75


5 6

Table 41 Table 41 IRD CASES FOR 2011 1.0 Late Arrival/Poor Attendance 13 2.0 Appeal for Reinstatement 11 3.0 Unethical Behaviour 14 4.0 Misappropriation of funds 10 5.0 Insubordination 1 6.0 Theft 1 7.0 Personal Grievances 2 8.0 Tempering with medical certificate 1 9.0 S/Harassment/extra marital affairs 6 10.0 Fraudulent activities 5 11.0 Lost Item 1 12.0 Poor Performance 14 13.0 Misconduct /negligence 3

The training division documented that 247 post service students were allotted the following scholarships and training in the MoH in 2011.

Table 42: Scholarship and Training (i)Masters

Table 42: Scholarship and Training (i)Masters

Type of students Sponsor Program New Ongoing Total MOH IAF WHO Aus

AID PSC PEI Private TICA Total

Master in Anesthesia

5 5 5 5

Master in Medicine – Internal Medicine

5

5

5

5

Master in Medicine Pediatrics

3

3

3

3

Master in Medicine Obs & Gynae

5

5

5

5

Master in Medicine Surgery

9

9

9

9

Master in Public Health

2 2 2 2

Master in Nursing Science

1 1 1 1


5 7

Table 43(ii) Post Graduate Diploma

Table 43 (ii) Post Graduate Diploma

Type of students Sponsor Program New Ongoing Total MOH IAF WHO AusAID PSC PEI Private TICA Total Post Graduate Diploma in Anesthesia

2

2

2

2

Post Graduate Diploma in Internal Medicine

3

3

3

3

Post Graduate Diploma in Obs & Gynae

3

3

3

3

Post Graduate Diploma in Surgery

4

4

4

4

Post Graduate Diploma in Public Health

1

1

1

1

Diploma in Dental Therapy

1 1 1 1

Diploma in Dental Technology

3

3

3

3

Diploma in Ophthalmology

7

7 7 7


5 8

Table 44(iii) BachelorTable 44

(iii) Bachelor

Type of students Sponsor Program New Ongoing Total MOH IAF WHO AusAID PSC PEI Private TICA Total Bachelor in Imaging Science

3 3 3 3

Bachelor in Physiotherapy

11 11 4 7 11

Bachelor of Environmental Health

5

5

5

5

Bachelor in Pharmacy

2 2 2 2

Bachelor in Medical Laboratory Science

3

3

2

1

3

Bachelor of Nursing Science

24 24 24 24

Post Graduate Diploma in Midwifery

45

45

45

45

Post Graduate Certificate in Mental Health

12

12

12

12

Post Graduate Advanced Diploma in Nursing (NP)

12

12

12

12


5 9

Table 45(iv) CertificateTable 45

(iv) Certificate

Type of students Sponsor Program New Ongoing Total MOH IAF WHO AusAID PSC PEI Private TICA Total Certificate in Health Service Management

6

6

6

6

Certificate in Community Development & Rehabilitation

29

29

29

29

Certificate in Phlebotomy

10 10 10 10

Trade Diploma in Front Line Management

31

31

31

31


6 0

SECTION 13.0: RESEARCH

A key event for the research unit this year was strengthening capacity building through Research Trainings and Workshops in a collaborative effort with the Research Department of the Fiji National University’s, College of Medicine and Health Sciences, WHO,WPRO and the Pacific Human Resources for Health Alliance. Through these collaborative efforts, the following Research Trainings were successfully conducted.

i. Medical Interns and Supervisors Training on Health Research Methodologies at the Lautoka and Labasa Hospitals, facilitated, supported and co-funded by the Ministry of Health’s Research Unit and College of Medicine and Health Sciences Research Department;

ii. Two (2) research training workshops for selected Ministry of Health Staff from the Northern, Central and Western Division on Research Proposal Writing; Writing for Publication and data Analysis & Basic Statistics, facilitated, supported, and co- funded by the Ministry of Health’s Research Unit and College of Medicine and Health Sciences Research Department;

iii. Expert Consultation on Improving Health Research Management, Governance and Data Sharing in the Western Pacific Region, coordinated and supported by WHO, WPRO Office in Manila, Philippines,;iv. Operational Research Methods Module 1 Training on Research Protocol Development facilitated by the International Union Against Tuberculosis and Lung Disease, coordinated and supported by Global Funds Grant Management Unit and College of Medicine and Health Sciences, Fiji National University and;

v. Human Resource for Health Tools Training supported and facilitated by WHO, WPRO and Pacific Human Resources for Health Alliance which focused on the development of capacity to analyze and provide policy support in the area of human resources among the Ministry of Health Staff and relevant stakeholders.


6 1

Table 46 : Research RegisterTable 46 :

Research Register

NHRC/

FNRERC N

o. Title of Research

Organization

Proposed Funder

Approval Status

Internal/Local External

1 2011- 001

Prevalence of

Metabolic

Disease in

Fijian Indian W

omen living in N

ew Zealand and Fiji: A

feasibility study

Masters Student

– Auckland

University

U

niversity of

Auckland Approved_FN

RERC

2 2011 002

A Baseline Study on "Understanding HIV and

AIDS risk and Vulnerability among Adolescents

and Young People in Fiji".

U

NICEF

U

NICEF

To be processed, pending submission of

other required documents

3 2011 003

Research Sam

pling on

Persistent O

rganic Pollutants (PO

Ps) using Human Breast M

ilk for the Global M

onitoring Plan Project

Dept

of Environm

ent

UN

ICEF To be processed, pending subm

ission of other required docum

ents

4 2011 004

Carries Experience and Body Mass Index (BM

I) Am

ong 12 year Olds in Suva, Fiji

CM

NHS Student-

Dept of

Health Sciences

CMN

HS

Approved_NHRC

6 2011 005

Patients Compliance to Anti-TB (treatm

ent) Drugs At Santo Hospital in Vanuatu

CM

NHS Student

Referred to CMN

HS – Regional Student

7 2011 006

Prevalence of Diabetes Nephropathy in Labasa

Hospital

CMN

HS Student CM

NHS

Approved_N

HRC

8 2011 007

Prevalence of Patients Onhaem

odialysis in Fiji

CMN

HS Student CM

NHS

Approved_N

HRC

9 2011 008

Patient View

s about

Waiting

Time

at O

utpatient Pharm

acy of

Solomon

Islands N

ational Referral Hospital

CM

NHS Student

Refered to CMN

HS – Regional Student


6 2


6 3


6 4


6 5


6 6


6 7


6 8

SECTION 14.0: HEALTH STATISTICS

Table 47: Vital StatisticsTable 47: Vital Statistics 2010 2011 Population 893024 901208 Women (15-44yrs) 211514 203,769 Total Live births 22089 20425 Crude Birth Rate /1000 population 24.7 22.7 Crude death Rate /1000 population 6.9 7.39 Rate of Natural Increase 1.8 1.53 Under 5 mortality rate/ 1000 livebirths (0-5 yrs) 17.7 20.95 Infant Mortality rate / 1000 live births (0-12months)

13.1 15.96

Perinatal Mortality (stillbirth and early neonatal deaths/1000 livebirths)

14.3 18.51

Early Neonatal (deaths 0-7days) /1000 livebirths 6.0 6.07 Neonatal Mortality (deaths 0-28days/ 1000 live births

8.0 8.52

Post-neonatal mortality (deaths 1-12 months)/ 1000 live births

5.1 7.51

Maternal mortality ratio /100,000 live births 22.6 39.2 General Fertility rate / 1000 CBA Population 104.4 100.24 Family Planning Protection Rate (per 1000 CBA Population)

31.8 36.5

*Note that perinatal mortality includes fetal deaths, regardless of the age of gestation of baby, which may have implications on survival.

*Note that perinatal mortality includes fetal deaths, regardless of the age of gestation of baby, which may have implications on survival.

Table 48: Immunization Coverage 211Table 48: Immunization Coverage 2011 Immunization Coverage (%) 0-1 yr 2010 2011 Number % Number % BCG 21806 98.7 19633 96.1 OPV0 21775 98.6 19670 96.3 HBV0 22518 101.9 19991 97.9 OPV1 17832 80.7 18632 91.2 Pentavalent1 17854 80.8 18640 91.3 OPV2 17743 80.3 18762 91.9 Pentavalent2 17781 80.5 18749 91.8 OPV3 16943 76.7 18536 90.8 Pentavalent3 17050 77.2 18517 90.7 MR1 13544 71.8 18226 82.5


6 9

Table 49: Notifiable Diseases Reported in 2011Table 49: Notifiable Diseases Reported in 2011 No. Diseases Total No. Diseases Total 1 Acute

Poliomyelitis 0 23 Meningitis 114

2 Acute Respiratory Infection

55736 24 Mumps 26

3 Anthrax 0 25 Plague 0 4 Brucellosis 0 26 Pneumonia 6828 5 Chickenpox 2,602 27 Puerperal Pyrexia 0 6 Cholera 0 28 Relapsing Fever 3 7 Conjunctivitis 10,633 29 Rheumatic Fever 7 8 Dengue Fever 111 30 Smallpox 0 9 Diarrhoea 25,207 31 Tetanus 0 10 Diphtheria 0 32 Trachoma 270 11 Dysentery a)

Amoebic 0 Tuberculosis a) Pulmonary* 172

b) Bacillary 307 33 b) Others* 41 12 Encephalitis 0 34 Typhus 0 13 Enteric Fever

a)Typhoid 439 35 Viral Infection 41,158

b) Para typhoid 0 36 Whooping Cough [Pertussis] 22 14 Fish Poisoning 1,540 37 Yaws 0 15 Food Poisoning 43 38 Yellow Fever 0 16 German Measles

(Rubella) 782 Sexually Transmitted

Infections

17 Infectious Hepatitis

174 a) Gonorrhoea 1,192

18 Influenza 20,371 b) Granuloma inguinale 0 19 Leprosy 4 c) Opthalmia

neonatorum 0

20 Leptospirosis 109 d) Lymphogranuloma inguinale

0

21 Malaria 0 e) Soft chancre 0 22 Measles

(Morbilli) 12 f) Syphilis 572

g) Veneral warts 3 h) Candidiasis 34 i) Chlamydia 189 j) Genital Herpes 15 k) Trichomoniasis 53 l) PID 1 m) Congenital Syphilis 20 n) Herpes zoster 59 Note that table 7.3 is based on: 73% of reports from the Divisions – 70% of Central, 59% of Western, 92% of Northern and 76% of Eastern. TB notifications provided by National TB Programme. Note that table 7.3 is based on: 73% of reports from the Divisions – 70% of Central, 59% of Western,

92% of Northern and 76% of Eastern. TB notifications provided by National TB Programme.


7 0

Table 50: Health Service Utilization Statistics – 2011

(i) Divisional and Sub-Divisional Hospital Utilization Statistics

ii Specialized and Private Hospitals

Table 50: Health Service Utilization Statistics – 2011 (i) Divisional and Sub-Divisional Hospital Utilization Statistics

No Institution

Number of

Number of Total Total

Occupancy

Daily Bed

Aver Length

Outpatient Beds

Admission

Patient Days Rate State of Stay

1 CWM Hospital 144,561 442 23,798 127,678 79.14 349.8 5.4

2 Navua Hospital 6,763 12 957 2,010 45.89 5.5 2.1

3 Vunidawa Hospital 7,252 23 647 1,873 22.31 5.1 2.9

4 Korovou Hospital 4,535 17 802 2,234 36.00 6.1 2.8

5 Nausori Hospital 25,254 17 2,318 3,334 53.73 9.1 1.4

6 Wainibokasi Hospital 20,500 12 969 3,799 86.74 10.4 3.9

Sub-total 208,865 523 29,491 140,928 73.82 386.1 4.8

7 Lautoka Hospital 153,686 341 13,449 93,319 74.98 255.7 6.9

8 Nadi Hospital 91,292 75 4,811 15,153 55.35 41.5 3.1

9 Sigatoka Hospital 34,212 58 2,827 9,755 46.08 26.7 3.5

10 Ba Mission Hospital 17,348 55 1,996 5,937 29.57 16.3 3.0

11 Tavua Hospital 25,112 29 1,360 4,271 40.35 11.7 3.1

12 Rakiraki Hospital 5,263 24 1,866 2,836 32.37 7.8 1.5

Sub-total 326,913 582 26,309 131,271 61.79 359.6 5.0

13 Labasa Hospital 154,160 161 9,575 45,060 76.68 123.5 4.7

14 Savusavu Hospital 14,971 56 1,652 5,905 28.89 16.2 3.6

15 Waiyevo Hospital 11,607 33 1,583 4,199 34.86 11.5 2.7

16 Nabouwalu Hospital 8,540 26 847 2,877 30.32 7.9 3.4

Sub-total 189,278 276 13,657 58,041 57.61 159.0 4.2

17 Levuka Hospital 24,504 40 1,269 3,163 364.00 8.7 2.5

18 Vunisea Hospital 8,678 22 474 2,050 25.53 5.6 4.3

19 Lakeba Hospital 4,743 12 362 1,054 24.06 2.9 2.9

20 Lomaloma Hospital 5,113 16 152 573 9.81 1.6 3.8

21 Matuku 2,040 5 122 278 15.23 0.8 2.3

22 Rotuma Hospital 3,598 14 159 623 12.19 1.7 3.9

Sub-total 48,676 109 2,538 7,741 19.46 21.2 3.1

TOTAL 773,732 1,490 71,995 337,981 62.15 926.0 4.7

GRAND TOTAL 795,788 1,733 72,898 381,709 60.34 1,045.

8 5.2

(ii) Specialized and Private Hospitals

No Institution

Number of


Occupancy

Daily Bed

Average Length

Outpatien

t Beds Admissi

on Patient

Days Rate State of Stay

1 St Giles Hospital 7,654 136 452 31,604 109.61 149.1 69.9

2 Tamavua/Twomey Hospital 12,496 91 216 11,690 35.19 32.0 54.1

4 Military Hospital 9 0.00 0.0 0

5 Naiserelagi Maternity 1,906 7 235 434 16.99 1.2 1.8

Sub-total 22,056 243 903 43,728 49.30 119.8 48.4 Note that above tables do not include the figures for RFMF. The reports from January-December are still pending.

Table 50: Health Service Utilization Statistics – 2011 (i) Divisional and Sub-Divisional Hospital Utilization Statistics

No Institution

Number of


Occupancy

Daily Bed

Aver Length

Outpatient Beds

Admission

Patient Days Rate State of Stay

1 CWM Hospital 144,561 442 23,798 127,678 79.14 349.8 5.4

2 Navua Hospital 6,763 12 957 2,010 45.89 5.5 2.1

3 Vunidawa Hospital 7,252 23 647 1,873 22.31 5.1 2.9

4 Korovou Hospital 4,535 17 802 2,234 36.00 6.1 2.8

5 Nausori Hospital 25,254 17 2,318 3,334 53.73 9.1 1.4

6 Wainibokasi Hospital 20,500 12 969 3,799 86.74 10.4 3.9

Sub-total 208,865 523 29,491 140,928 73.82 386.1 4.8

7 Lautoka Hospital 153,686 341 13,449 93,319 74.98 255.7 6.9

8 Nadi Hospital 91,292 75 4,811 15,153 55.35 41.5 3.1

9 Sigatoka Hospital 34,212 58 2,827 9,755 46.08 26.7 3.5

10 Ba Mission Hospital 17,348 55 1,996 5,937 29.57 16.3 3.0

11 Tavua Hospital 25,112 29 1,360 4,271 40.35 11.7 3.1

12 Rakiraki Hospital 5,263 24 1,866 2,836 32.37 7.8 1.5

Sub-total 326,913 582 26,309 131,271 61.79 359.6 5.0

13 Labasa Hospital 154,160 161 9,575 45,060 76.68 123.5 4.7

14 Savusavu Hospital 14,971 56 1,652 5,905 28.89 16.2 3.6

15 Waiyevo Hospital 11,607 33 1,583 4,199 34.86 11.5 2.7

16 Nabouwalu Hospital 8,540 26 847 2,877 30.32 7.9 3.4

Sub-total 189,278 276 13,657 58,041 57.61 159.0 4.2

17 Levuka Hospital 24,504 40 1,269 3,163 364.00 8.7 2.5

18 Vunisea Hospital 8,678 22 474 2,050 25.53 5.6 4.3

19 Lakeba Hospital 4,743 12 362 1,054 24.06 2.9 2.9

20 Lomaloma Hospital 5,113 16 152 573 9.81 1.6 3.8

21 Matuku 2,040 5 122 278 15.23 0.8 2.3

22 Rotuma Hospital 3,598 14 159 623 12.19 1.7 3.9

Sub-total 48,676 109 2,538 7,741 19.46 21.2 3.1

TOTAL 773,732 1,490 71,995 337,981 62.15 926.0 4.7

GRAND TOTAL 795,788 1,733 72,898 381,709 60.34 1,045.

8 5.2

(ii) Specialized and Private Hospitals

No Institution

Number of


Occupancy

Daily Bed

Average Length

Outpatien

t Beds Admissi

on Patient

Days Rate State of Stay

1 St Giles Hospital 7,654 136 452 31,604 109.61 149.1 69.9

2 Tamavua/Twomey Hospital 12,496 91 216 11,690 35.19 32.0 54.1

4 Military Hospital 9 0.00 0.0 0

5 Naiserelagi Maternity 1,906 7 235 434 16.99 1.2 1.8

Sub-total 22,056 243 903 43,728 49.30 119.8 48.4 Note that above tables do not include the figures for RFMF. The reports from January-December are still pending.

Note that above tables do not include the figures for RFMF. The reports from January-December are still pending.


7 1

Table 51: Morbidity and Mortality Statistics – 2011 (i) Top ten causes of mortality – 2011

Table 51 Top ten causes of morbidity – 2011 (ii) Top ten causes of Morbidity – 2011


7 2

Table 52: Health Status Indicators 2011

9 Survey required (to report prevalence). At last NCD STEPS Survey (2002), prevalence was 16%

10 In the published 2010 report, 36.6 was reported. However, ICD codes [E10.2-E10.8, E11.2-E11.8, E13.2-E13.8, E14.2-E14.8, I00-I52.8] have been used to report this indicator in 2011, hence the 2010 figure has been updated in this report for comparison

11 Survey required to report prevalence

12 From National Oral Health Survey, 2004


7 3

Whilst the mortality rate from tuberculosis, cancer and motor vehicle accidents increased slightly in 2011 compared to 2010, the mortality rate from cardiovascular disease decreased. The incidence rates for some of the communicable diseases such as Dengue, Leptospirosis and measles increased in 2011 compared to the previous year. With regards to STIs, the rates of Gonorrhoea remained stable and lower incidence of Syphilis was reported in 2011 compared to 2010. Our skilled birth attendance continues to be above 95%. Half the number of teenage suicides was reported in 2011 compared to the previous year.


7 4

mortality Prevalence of under 5 malnutrition 14 14

% of one year fully immunized 71.8 82.5

Under 5 mortality rate/ 1000 births 17.7 20.95

Infant mortality rate (1000 live births) 13 15.96

Improved adolescent health and reduced adolescent morbidity and mortality

Rate of teenage pregnancy (per 1000 CBA pop) 3.8 2.98

Number of teenage suicides 14 7

Whilst the mortality rate from tuberculosis, cancer and motor vehicle accidents increased slightly in 2011 compared to 2010, the mortality rate from cardiovascular disease decreased. The incidence rates for some of the communicable diseases such as Dengue, Leptospirosis and measles increased in 2011 compared to the previous year. With regards to STIs, the rates of Gonorrhoea remained stable and lower incidence of Syphilis was reported in 2011 compared to 2010. Our skilled birth attendance continues to be above 95%. Half the number of teenage suicides was reported in 2011 compared to the previous year.

SECTION 15.0: OVERSEAS PATIENT REFERRAL 2011

Table 53: Types of cases Assisted for overseas treatment from 2009-2011Table 53: Types of cases Assisted for overseas treatment from 2009-2011 NO# Cases 2009 2010 2011 Total

1 Cardiac 39(47.5%) 45(48%) 97(47.8%) 181(47.9%) 2 Cancer 14(17%) 26(28%) 50(24.7%) 90(23.9%) 3 Kidney 6(7.3%) 2(2%) 7(3.4%) 15(3.9%) 4 Knee/hip replacement 6(7.3%) 11(11.8%) 14(6.9%) 31(8.3%) 5 Tumour 8(9.7%) 4(4.3%) 0 12(3.1%) 6 Eye 9(10.9%) 5(5.3%) 25(12.3%) 39(10.3%) Others 10(4.9%) 10(2.6%)

Total 82 93 203 378

Table 54: Analysis by Diagnosis and associated costsTable 54: Analysis by Diagnosis and associated costs NO# Diagnosis NO# % Cost

1 Cardiac 97 47.8 $592,822.89 2 Cancer 50 24.7 $183,192.29 3 Kidney 7 3.4 $28,093.00 4 Knee/hip replacement 14 6.9 $98,993.32 5 Tumour 0 0 $54,859.06 6 Eye 25 12.3 $85,359.19 7 Others 10 4.9 $20,812.69

Total 203 100 $1,064,132.44


7 5

SECTION 16.0: Disease Trend Analysis

Figure 23 : Diabetes Cases from 2000-2011Figure 23 : Diabetes Cases from 2000-2011

525 535

406 394

228 209

544

415

352 354

443

645

0

100

200

300

400

500

600

700

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Tota

l

Year

Total Diabetes Cases for the Year 2000-2011

Figure 24: Cancer Cases from 2000-2011Figure 24: Cancer Cases from 2000-2011

499 566

425 365

495 395

304

466 465 453

1189 1091

0

200

400

600

800

1000

1200

1400

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Tota

l

Year

Total Cancer Cases for the Year 2000-2011


7 6

Figure 25: Sexually Transmitted Infection Cases from 2000-Figure 25: Sexually Transmitted Infection Cases from 2000-2011

0

200

400

600

800

1,000

1,200

1,400

1,600

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Num

ber o

f Cas

es

Years

Sexually Transmitted Infections, 2000-2011

Gonorrhoea

Syphilis

Figure 26: Cardiac Related Cases from 2000-2011Figure 26: Cardiac Related Cases from 2000-2011

0

2000

4000

6000

8000

10000

12000

14000

16000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No. of Cases

Total Cases for Cardiovascular Diseases from 2000 - 2011


7 7

Figure 27: Depression cases from 2001-2011Figure 27: Depression cases from 2001-2011

Figure 28: Kidney cases from 2000-2011Figure 28: Kidney cases from 2000-2011

0

100

200

300

400

500

600

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

No.of Cases

Year

Total Kidney cases from 2000 - 2011


7 8

Figure 29: Typhoid cases from 2000-2011Figure 29: Typhoid cases from 2000-2011

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011Typhoid Fever 0 8 4 26 7 117 167 299 426 410 530 439

0

100

200

300

400

500

600

No

of C

ases

Year

Typhoid Fever Cases 2000 - 2011

Figure 30: Typhoid cases by Divisions 2000-2011Figure 30: Typhoid cases by Divisions 2000-2011

Majority of the Typhoid cases over the past decade have been reported from the Northern Division, particularly in 2008.

0

50

100

150

200

250

300

350

Central Western Northern Eastern

No.

of C

ases

Divsions

Typhoid Cases by Divisions 2000 - 2011

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

2011


7 9

Figure 31: Dengue Fever cases from 2000-2011Figure 31: Dengue Fever cases from 2000-2011

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011Dengue Fever 14 3 170 2,762 84 27 34 53 1,895 430 8 111

0

500

1000

1500

2000

2500

3000

No.

of C

ases

Year

Dengue Fever cases for 2000 - 2011

Figure 32: Leptospirosis cases from 2000-2011Figure 32: Leptospirosis cases from 2000-2011

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011Leptospirosis 65 107 83 50 76 53 43 92 83 154 88 109

0

20

40

60

80

100

120

140

160

180

No.

of C

ases

Year

Leptospirosis cases for 2000 - 2011


8 0

SECTION 17.0:

Donor Assisted Programs/Projects 2011

Table 55

Table 55 (i) Aid-In-Kind

Donor Program Amount Aus Aid Fiji Health Sector Improvement Programme $8,904,719 China Navua Hospital Relocation & Construction $7,800,000 NZ AID Medical Treatment Scheme 415,110 NZ AID Water Reservoir Labasa Hospital 484,295 NZ AID Construction of New Nacavanadi N/S 1,378,700 JICA Strengthening Immunisation Program in the

Pacific Region 565,291

JICA Filariasis Elimination Campaign 158,281 WHO Assistance 2,152,171 JICA Inservice Training – Community Health Nurses 2,261,164 JICA Volunteer 217,071 Total 24,336,802

Table 55 (i) Cash Grant

Donor Program Amount UNDP Fiji National Aids Spending Assessment $ 57,056 UNFPA Reproductive Health Programme $ 165,000 UNICEF Health & Sanitation $ 340,000 UNICEF HIV & AIDS $ 220,000 WHO Assistance $ 231,468 Total $1,013,524

(i) Cash Grant

(i) Aid-in-Kind


8 1

SECTION 18.0: MDG Performance Indicator Results

Table 56


8 2

GOAL 4 REDUCE CHILD MORTALITY RATE Year Percentage Under 5 Mortality Rate (per 1000 livebirths) [Reduce by 2/3 between 1990 and 2015 the under 5 mortality; 2015 target – 9.2]

2009 23.2

2010 17.7 2011 20.95 Proportion of 1 year old immunized against Measles [2015 target - 95%]

2009 71.7

2010 71.8 2011 82.5 GOAL 5 IMPROVE MATERNAL HEALTH Maternal Mortality Ratio per 100,000 livebirths [Reduce by ¾ MMR between 1990 and 2015; 2015 target – 10.3]

2009 27.5

2010 22.6 2011 39.2 GOAL 6 COMBAT HIV/AIDS AND OTHER DISEASES HIV/AIDS prevalence among 15-24 year old pregnant women

2009 3

2010 3 2011 3 Contraceptive Prevalence Rate among population of child bearing age

2009 28.9

2010 31.77 2011 36.5 Proportion of TB cases detected and cured under DOTS (%)

2009 80

2010 2011 8

2015 – Have halved and begun to reverse the spread of HIV/AIDS and other diseases

SECTION 19.0: Finance

Figure 33: Auditors Report


8 3


8 4

19.1 FINANCE

Revised Budget allocation for 2011 was $137,448,400 corresponding to 7% of the national budget and 2.1% as a percentage of the 2011 GDP. An additional sum of $1,013,524 was given as cash grants towards donor funded projects and $24,336,802 as Aid-In-Kind projects in 2011.

Table 57: Segregation of the 2011 BudgetTable 57: Segregation of the 2011 Budget Program/Activity Total Budget % over the Total

Health Budget Program 1 Activity 1 - Administration $ 14,802,800 10.76% Program 1 Activity 2 - Research $ 570,900 .41% Program 2 Activity 1 – Urban Hospitals $ 65,338,200 47.53% Program 2 Activity 2 – Sub-divisional Hospitals, Health Centres and Nursing Stations

$ 29,732,600 21.63%

Program 2 Activity 3 – Public Health Services $ 4,434,500 3.25% Program 2 Activity 4 – Drugs and Medical Supplies

$ 18,712,000 13.62%

Program 3 Activity 1 – Hospital Services $ 3,002,800 2.18% Program 4 Activity 1 – Senior Citizen’s Home $ 854,500 .62% Total Budget $137,448,400 100.00%

Table 58: Proportion against National Budget and GDP.Table 58: Proportion against National Budget and GDP. Year Health Revised

Budget National Budget % over Total

Budget % of GDP

2011 $ 137,448,400 $ 1,961,718,300 7% 2.1%


8 5

Table 59: Statement of Receipts and Expenditure for the Year Ended 31st December, 2011.

Table 59: Statement of Receipts and Expenditure for the Year Ended 31st December, 2011. RECEIPTS Note 2011 2010 State Revenue Operating Revenue 1 (1,539,198) (585,771)

Total State Revenue (1,539,198) (585,771)

Agency Revenue Health Fumigation & Quarantine 2 (1,564,660) (191,412) Hospital Fees 2 (1,743,889) (1,020,470) License & Others 2 (1,025,088) (527,769) Fiji School of Nursing 2 (299,095) (405,966)

Total Agency Revenue (4,632,732) (2,145,167)

TOTAL RECEIPTS (6,171,775) (2,731,388)

EXPENDITURE

Operating Costs Established Staff 3 72,989,484 71,249,021 Government Wage Earners 3 12,909,145 12,617,553 Travel &Communications 3,408,206 3,292,880 Maintenance & Operations 10,465,683 9,992,150 Purchase of Goods & Services 27,161,305 25,678,965 Operating Grants & Transfers 535,273 6,286,607 Special Expenditure 4,590,805 3,635,770

Total Operating Costs 132,059,991 132,752,946

Capital Expenditure Capital Construction 5,275,078 5,044,490 Capital Purchase 5,861,255 6,580,228 Capital Grants & Transfers 0 200,000

Total Capital Expenditure 11,136,334 11,824,718

Value Added Tax 6,587,707 9,252,515

TOTAL EXPENDITURE 149,784,032 153,830,178


8 6

Table 60: TMA Trading Account for the Year Ended 31st December, 2011.

Table 60: TMA Trading Account for the Year Ended 31st December, 2011.

Trading Account

Sales $ (591,885.74)

Less Cost of Goods Sold Stock of Finished Goods (01/01/11) $ 38,721.13

Add Purchases

330,105.53

368,826.66

Less Stock of Finished Goods (31/12/11) $ 30,539.34

Cost of Finished Goods Sold $ 338,287.32

Gross (Profit) / Loss Transferred to P&L A/C $ (253,598.42)

Table 61: TMA Profit and Loss Statement for the Year Ended 31 December, 2011.

Table 61: TMA Profit and Loss Statement for the Year Ended 31 December, 2011.

Income Gross (Profit) / Loss Transferred from Trading

A/C $ (253,598.42) Expenses

Wages & Salary $ -

Travel & Communication $ 1,905.79

Maintenance and Operations $ 25,262.88

Other Expenses $ -

Special Expenses $ -

Vat $ 4,075.30

Total Expenses $ 31,243.97

Net (Profit) / Loss $ (222,354.45)


8 7

Table 62: TMA Balance Sheet for the Year Ended 31 December, 2011.Table 62: TMA Balance Sheet for the Year Ended 31 December, 2011.

CURRENT LIABILITIES

Accounts Payable

-

Accrued Expenses

-

Deposits & Deductions

(32,493.16)

Total Liabilities

(32,493.16) EQUITY

TMA SURPLUS CAPITAL RETND TO CFA $ (39,827.63)

TMA ACCUM SURPLUS/DEFICIT $ (967,165.03)

Total Equity $ (1,006,992.66)

TOTAL LIABILITIES AND EQUITY $ (1,039,485.82)

CURRENT ASSETS

Bank $ 950,739.89

Debtors $ 58,206.59

Finish Goods $ 30,539.34

TOTAL ASSETS $ 1,039,485.82

Table 63: Appropriation Statement for the Year Ended 31 December 2011.Table 63: Appropriation Statement for the Year Ended 31 December 2011.

Seg Item Budget Appropriation Revised Actual Carry Lapsed

Estimate Changes Budget Expenditure Over Appropriation

OPERATING EXPENDITURE

1 ESTABLISHED STAFF 61,835,100 0 61,835,100 72,989,484 0 -11,154,384

2 GOVERNMENT WAGE EARNERS 9,571,089

9,571,089 12,909,145 0 -3,338,056

3 TRAVEL & COMMUNICATION 3,633,348 -150,000 3,483,348 3,408,296 0 75,052

4 MAINTENANCE & OPERATIONS 9,697,100 957,187 10,654,287 10,465,683 0 188,604

5 PURCHASE OF GOODS & SERVICES 26,329,282 -629,458 25,699,824 27,161,305 0 -1,461,480

6 OPERATING GRANTS & TRANSFERS 1,080,780 -215,403 865,377 535,273 0 330,104

7 SPECIAL EXPENDITURE 6,740,500 -878,527 5,861,973 4,590,805 0 1,271,168

TOTAL OPERATING EXPENDITURE 118,887,199 -916,201 117,970,998 132,059,991 0 -14,088,992

CAPITAL EXPENDITURE

8 CONSTRUCTION 4,700,000 606,274 5,306,274 5,275,078 0 31,196

9 PURCHASE 5,520,000 282,676 5,802,676 5,861,255 0 -58,579

TOTAL CAPITAL

EXPENDITURE 10,220,000 888,950 11,108,950 11,136,333 0 -27,383

13 VALUE ADDED TAX 8,341,200 27,251 8,368,451 6,587,707 0 1,780,744

TOTAL EXPENDITURE 137,448,399 0 137,448,399 149,784,032 0 -12,335,633


8 8

Notes on significant variations.

1 State revenue increase by 100 % due to fines, surcharges, and recoveries of OPR for previous years.

2 Agency revenue increase by 100% in total due to the increase of hospital & Quarantine fees in 2011.

3 Staff costs increase by 1.2% mainly due to increase of claims of overtime, allowances. Also the Personnel Emolument provision is not sufficient to meet the salaries and wages of staff employed in the Ministry.


8 9

SECTION 20.0: CONCLUSION

Fiji’s health system has confronted many obstacles and challenges in 2011 in measuring the performance of our health systems. The WHO framework of the 6 building blocks of measuring the efficiency and effectiveness of how well the health systems performs i.e. Health Service Delivery, Health Workforce, Health Information, Health Financing, Health Medicines, Vaccines, Technology including Infrastructure and Health Leadership and Governance provides an opportunity for developing countries to adopt such mechanisms and respond to the obstacles and challenges in a more systematic manner to ensure that every dollar spent is used in the most cost effective manner for the most cost effective intervention.

The framework also provides a systematic approach in meeting the MDG’s but all building blocks are to run parallel to one another if we are to achieve our targets.

We are indeed grateful to our international and national development partners who have provided continued assistance for health systems strengthening through harmonization of their programs to our strategic activities.

The Ministry of Health will continue to be innovative and productive in delivering an equal and equitable health service to its people of Fiji and ensure quality health care is driven by a quality work-force that puts the interest of the people first.

May God Bless Fiji.


9 0

Documents

Ministry of Health Annual report 2011